Title Stupanj hipertrofije lijeve klijetke i incidencija srčanih aritmija u bolesnika s hipertenzivnom bolesti srca : doktorska disertacija
Author Juraj Kunišek
Mentor Luka Zaputović (mentor)
Committee member Žarko Mavrić (predsjednik povjerenstva)
Committee member Anton Šmalcelj (član povjerenstva)
Committee member Jagoda Ravlić-Gulan (član povjerenstva)
Granter University of Rijeka Faculty of Medicine Rijeka
Defense date and country 2008-01-01, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences
Universal decimal classification (UDC ) 616 - Pathology. Clinical medicine
Abstract Cilj istraživanja. Ispitati vezu između tipa odnosno stupnja hipertrofije lijeve klijetke i učestalosti supraventrikularnih i ventrikularnih aritmija u hipertenzivnih bolesnika s hipertrofijom lijeve klijetke.
Ispitanici i metode. U istraživanje je uključeno ukupno l92 bolesnika (87 muškaraca i 105 žena) u dobi od 43 do 90 godina. Ispitanici su podijeljeni u tri glavne skupine s obzirom na tip hipertrofije lijeve klijetke (koncentrična, ekscentrična i asimetrična hipertrofija) i na tri podskupine s obzirom na stupanj hipertrofije (blaga, umjerena i teška). Uz kliničke i laboratorijske podatke svima su određeni čimbenici kardiovaskularnog rizika, indeks tjelesne mase, površina tijela, učinjena rentgenska snimka srca i pluća, fundoskopija, a nakon obustave svih lijekova tijekom 48 sati izmjereni krvni tlak, frekvencija srca, elektrokardiografski podaci, ehokardiografski podaci, određena učestalost supraventrikularnih i ventrikularnih aritmija Holter monitoringom i bicikl ergometrijom. Bolesnici s izoliranom sistoličkom hipertenzijom na kraju su posebno obrađeni.
Rezultati. Najčešći tip hipertrofije lijeve klijetke je koncentrična (63%), zatim ekscentrična (28%). Teška hipertrofija lijeve klijetke nalazi se u 10% bolenika. Bolesnici s ekscentričnom hipertrofijom imaju značajno veći indeks mase lijeve klijetke od onih s koncentričnom (p=0.011). Supraventrikularne aritmije javljaju se češće od ventrikularnih (93% prema 80%, p=0.002). Prevalencija supraventrikularnih ekstrasistola je veća u koncentričnom i ekscentričnom tipu nego u asimetričnom (p=0.048). Njihova učestalost korelira sa stupnjem hipertrofije lijeve klijetke (značajno u muškaraca s koncentričnim tipom, p=0.015). Atrijalna fibrilacija ili supraventrikularna paroksizmalna tahikardija su pronađene u 43% bolesnika. Nema korelacije između prevalencije atrijalne fibrilacije/supraventrikularne paroksizmalne tahikardije i stupnja (p=0.607) odnosno tipa (p=0.455) hipertrofije lijeve klijetke. Složene ventrikularne aritmije tijekom Holter monitoringa pronađene su u preko 40% bolesnika. Nema statistički značajne ralike među grupama u učestalosti jednostavnih (p=0.757) i složenih (p=0.657, p=0.819, p=0.617, za politopne, parove i ventrikularne tahikardije) ventrikularnih aritmija. Veća prevalencija ventrikularnih aritmija pronađena je kod umjerenog i teškog stupnja za sve tipove. Kod koncentričnog tipa razlika je statistički značajna za jednostavne ventrikularne aritmije (p=0.042). Ventrikularne tahikardije češće se javljaju u muškaraca nego žena (18% prema 7%, p=0.024). Tlak pulsa značajno je veći u koncentričnom tipu (p=0.00073) i blago raste s težinom hipertrofije (ne značajno). QTc interval i QT disperzija većih su vrijednosti kod teške koncentrične i ekscentrične LVH, ne značajno (u muškaraca se duljina QTc intervala povećava sa stupnjem LVH, p=0.081)). QT disperzija je značajno veća u muškaraca s teškom LVH (p=0.047). Duljina QT intervala značajno je veća u kategoriji složenih ventrikularnih aritmija (Lown III-V) nego u kategoriji jednostavnih ventrikularnih aritmija (p=0.037). QTc interval ima samo istu tendenciju.
Zaključak. Koncentrična i ekscentrična hipertrofija lijeve klijetke imaju veći učinak na pojavnost atrijalnih aritmija, a umjerena i teška koncentrična predstavlja veći rizik za ventrikularne aritmije. Prevalencija srčanih aritmija (QTc interval i QT disperzija) korelira sa stupnjem hipertrofije lijeve klijetke. Asimetrični tip hipertrofije ne znači povećan rizik, također ni izolirana sistolička hipertenzija. Tlak pulsa izgleda ima najveći utjecaj na geometriju lijeve klijetke. Bolesnici sa umjerenom i teškom koncentričnom i ekscentričnom hipertrofijom lijeve klijetke trebaju biti uvijek testirani Holter monitoringom i testom opterećenja i liječeni maksimalno podnošljivom dozom antihipertenziva, osobito inhibitorima angiotenzin konvertaze ili blokatorima angiotenzinskih receptora.
Abstract (english) The aim of the investigation. To study the association between the degree, i.e., type of left ventricular hypertrophy and the prevalence of supraventricular and ventricular arrhythmias in hypertensive patients with left ventricular hypertrophy.
Subjects and Methods. The investigation included a total of 192 patients (87 men and 105 women) aged between 43 and 90 years. The subjects were divided into three main groups with regard to the left ventricular hypertrophy type (concentric, eccentric and asymmetric hypertrophy) and three subgroups in relation to the degree of hypertrophy (mild, moderate and severe). Clinical and laboratory assessment also included cardiovascular risk factors, body mass index, body surface, chest x-ray and funduscopy. After a 48-hours medication discontinuance blood pressure and heart rate were measured, electrocardiography and echocardiography performed and ventricular and supraventricular arrhythmia frequency assessed by Holter monitoring and bicycle ergometry. Finally, patients with isolated systolic hypertension were separately evaluated.
Results. The most frequent left ventricular hypertrophy is concentric (64%) followed by eccentric (27%). Severe left ventricular hypertrophy was found in 10% of patients. Patients with eccentric left ventricular hypertrophy had a significantly higher left ventricular mass index then those with concentric left ventricular hypertrophy (p=0.011). Supraventricular arrhythmias are more frequent than ventricular (93% vs. 80%, p=0.002). The prevalence of supraventricular premature beats was higher in the concentric and eccentric than in the asymmetric type (p=0.048) Their incidence correlates with the degree of left ventricular hypertrophy (significantly in men with the concentric type, (p=0.015). Atrial fibrillation, or paroxysmal supraventricular tachycardia were found in 43% of patients. The analysis showed no significant correlation between the prevalence of atrial fibrillation and/or paroxysmal supraventricular tachycardia and the degree (p=0.607) as well as the type of left ventricular hypertrophy (p=0.455). Complex ventricular arrhythmias during Holter monitoring were identified in over 40% of patients. There was no statistically significant difference between groups in frequency of simple (p=0.757) and complex (p=0.657, p=0.819, p=0.617, for polytopic, pairs and ventricular tachycardia, respectively) ventricular arrhythmias. Increased prevalence of ventricular arrhythmias was found for the moderate and severe degree in all types. In the concentric type the difference is statistically significant for simple ventricular arrhythmias (p=0.042). Ventricular tachycardia is more frequent in men than women (18% vs. 7%, p=0.024). The pulse pressure is significantly higher in the concentric type (p=0.00073) and slowly increases with the severity of hypertrophy (not significantly). QT and QTc intervals and QT dispersion are higher in more severe, concentric and eccentric types, not significantly (in men the length of QTc intervals increases with the degree of left ventricular hypertrophy, p=0.081). QT dispersion is significantly higher in men with severe left ventricular hypertrophy (p=0.047). The length of QTc intervals is significantly higher in the category of compelx ventricular arrhythmias (Lown III-V) then in the category of simple (p=0.037). For QTc the correlation has only tendency to increase.
Conclusion. Concentric and eccentric types have a greater impact on the frequency of atrial arrhythmias, and moderate and severe concentric left ventricular hypertrophy represents the greatest risk for ventricular arrhythmias. The prevalence of cardiac arrhythmias (QTc interval and QT dispersion) correlates with the degree of left ventricular hypertrophy. The asymmetric type of hypertrophy does not represent a higher risk, nor does the isolated systolic hypertension. The pulse pressure appears to have the greatest influence on the geometry of the left ventricle. Patients with moderate and severe concentric and eccentric left ventricular hypertrophy should be always tested by Holter monitoring and bicycle ergometry and treated with maximally tolerable doses of antihypertensives, particularly with angiotensin converting enzyme inhibitors or angiotensin receptor blockers.
Keywords
Hipertenzija
Hipertrofija lijeve klijetke
asimetrična
ekscentrična
koncentrična
QT interval
Supraventrikularne aritmije
Ventrikularne aritmije.
Keywords (english)
Hypertension
Left ventricular hypertrophy
asymmetric
eccentric
concentric
QT interval
Supraventricular arrhythmias
Ventricular arrhythmias
Language croatian
URN:NBN urn:nbn:hr:188:302191
Study programme Title: Biomedicine Postgraduate (doctoral) study programme Study programme type: university Study level: postgraduate Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
Catalog URL http://libraries.uniri.hr/cgi-bin/ucat/unilib.cgi?form=D1111205094
Type of resource Text
Extent 151 str; 30 cm
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Created on 2017-01-19 17:19:54