Статья
Гипертрофия левого желудочка при артериальной гипертензии и риск развития аритмий
Гипертрофия левого желудочка (ГЛЖ) является значимым независимым фактором риска не только общей и сердечно-сосудистой смертности, но и внезапной сердечной смерти. Вслед за повышением давления в гипертрофированном ЛЖ на фоне диастолической дисфункции миокарда очень быстро расширяется левое предсердие. Это приводит к возникновению наджелудочковой экстрасистолии, трепетанию и фибрилляции предсердий у 25%-50% пациентов с артериальной гипертонией (АГ). Связь между ГЛЖ, частотой и степенью выраженности желудочковых аритмий зависит от степени ГЛЖ и может отсутствовать на более близких к физиологическим ранних и средних стадиях. Ассоциация между ГЛЖ и спонтанно индуцированной желудочковой аритмией была подтверждена в хорошо контролируемых, экспериментальных исследованиях. К факторам аритмогенного риска у больных АГ с ГЛЖ относятся: поздние потенциалы желудочков, уменьшение вариабельности сердечного ритма, увеличение продолжительности QRS-комплекса и дисперсии интервала QT, а также альтернации Т-волны. Оценка риска развития аритмий у бессимптомных больных - трудная задача, которая может быть решена с помощью предложенного алгоритма.
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