原发性高血压左心室不同构型心律失常的比较

Comparison of arrhythmias among different left ventricular geometric patterns in essential hypertension

目的 研究原发性高血压患者左心室重构不同构型间心律失常的差异。方法 179例原发性高血压患者均进行了 2 4h动态心电图、动态血压监测、超声心动图等检查 ,根据检查结果划分左心室构型、判定心律失常 ,比较左心室重构组与正常构型组心律失常的发生率 ;通过多元逐步回归分析 ,甄选出对心律失常有独立影响的因素 ,并在校正这些影响因素后 ,比较左心室不同构型间心律失常严重程度的差异。结果 左心室重构组的房性心律失常、室性心律失常、复杂室性心律失常的发生率均显著高于正常构型组。而影响原发性高血压心律失常的相对独立因素很多 ,其中部分左心室解剖结构指标、高血压分级、左心房内径、E/A值、夜间舒张压负荷值以及日平均心率等占重要地位 ;校正上述影响因素后 ,不同构型两两比较时 ,部分构型之间心律失常分级级别仍存在差异 ,且差异为构型本身差异所致。结论 原发性高血压心律失常的影响因素很多 (例如高血压分级、左心室重量指数、左心房内径、左心室后壁厚度等 ) ,不同构型间心律失常的严重程度存在差异。

Objective The aim of this study is to investigate the differences of arrhythmias among distinct left ventricular geometric patterns in patients with essential hypertension.Methods One hundred and seventy nine patients with essential hypertension were examined with 24-hour ambulatory ECG monitoring,ambulatory blood pressure monitoring as well as echocardiography.Left ventricular geometric patterns and arrhythmias were identified according to the results of above examinations.The differences of morbidities of arrhythmia were compared between the left ventricular remodeling group and the normal geometric pattern group.The method of multiple stepwise regression analysis was applied to identify the independent determinants of arrhythmias.The severity of arrhythmias among different left ventricular geometric patterns was compared after these predictors were controlled or adjusted.Results Morbidities of atrial and ventricular arrhythmia as well as that of complex ventricular arrhythmias in left ventricular remodeling group was higher than that in normal geometric pattern group.And there were many independent influencing factors on arrhythmias in patients with essential hypertension.Of all these factors,some indices of left ventricular anatomic structure,grade of hypertension,left atrial inner dimension,E/A ratio,nocturnal diastolic blood pressure load and daily average heart rate played an important role in the genesis of arrhythmias.After the above-mentioned factors were adjusted,the differences of the orders of arrhythmias between partial geometric patterns were reserved,which resulted from the differences of the geometric patterns.Conclusions Many factors contributed to arrhythmias in patients with essential hypertension,such as grade of hypertension,left ventricle mass index,left atrial inner diameter and postal wall thickness.The severity of arrhythmias was different in each left ventricular geometric pattern.