NGHIEN Ciru LAM SANG
Nguy CO ro'i loan nhip tim 6 benh tim tang huye't ap
P h a m T h a i G i a n g , V u D i e n Bien, H o a n g M i n h Chan B e n h v i e n T r u n g u a n g Q u a n d p i 108
TiM TAT:
Nghien cthi nguy ca roi loan nhip tim (RLNT) bang Holter di^n tim 24 gio tren 365 b#nh nhan tang huye't ap (THA) va 85 ngucri binh thuong, cac nhom phii hgp ve tuoi, gidi, chi so'khoi co the (BMI). Trong nhom THA co 39,5% phi dai that trai (PDTT), 11,4% co EF < 50%, 9,8% co nhoi mau CO tim (NMCT) cti. Ke't qua cho thay THA la ye'u to lam tang nguy CO roi loan nhip (RLN) tiren that len 5,4 lan va tang RLN that len 5,1 lan. Tuoi > 60 lam tang nguy co RLN tren that len 2,4 lan va RLN that len 1,97 lan, RLN tiiat phiic tap len 2,2 \an. Thoi gian phat hien benh THA tren 5 nam la ye'u to nguy ca Iam tang RLN tha't len 1,9 lan va RLN thai phiic tap len 3,2 lan. THA co PDTT lam tang nguy co RLN tren tha't, RLN tiia't, RLN tha't phiic tap len lan luoi: la 4,5 lan; 3,5 lan; 4,7 lan. THA co NMCT cii lam tang nguy co RLN that len 3,5 lan va RLN thai phiic tap len 5,6 lan.
THA CO EF < 50% lam tang nguy co RLN tren that len 6 lan, tang nguy co RLN that len 19,2 lan, RLN that phtic tap len 24,9 lan.
flAT VAN BE
Tang huye't a p (THA) la m p t ye'u to n g u y CO q u a n trpng doi vdi roi loan n h i p (RLN) tren that, RLN that va d o t t u tim mach. Cac b a n g chiing da chi ra TFIA k h o n g nhiing la yeii to' n g u y co m a con d o n g vai tro trtJc tie'p gay n e n n h i i n g RLN nay [1]. RLN tim (RLNT) 6 b e n h n h a n T H A n g a y cang d u p c q u a n tam vi tan sua't gap cao, a n h h u o n g tdi ty le tii v o n g va chat l u p n g cupc s o n g [2], 6 giai d o a n d a u etia T H A hoac THA m a ehua co p h i dai that tirai (PDTT) thi RLNT tiiuong it gap 13]. Khi da co rihimg bieh doi ve ca'u trtie va chiic n a n g nhi trai, that trai n h u gian nhi trai, PDTT, gian that trai, nhoi m a u eo tim (NMCT), suy tim... thi d o la nhihig n g u y co co b a n gay RLNT.
NTiung nghien ctiu gan day da chiing
mirth PDTF lam t a n g t i n h d e ton thuong d o thieu m a u va la n g u y e n n h a n chinh d i n d&i RLNT 6 b e n h n h a n TFIA [2,4].
Tren Holter dien tim n h i i n g RLN gom RLN tren t h a t n h u ngoai t a m t h u (NTT) tren that, n h i p n h a n h tren that, r u n g nhi;
eac RLN that n h u N T T tiia't eac mtic dp, con n h a n h that, r u n g tiia't... Ve lam sang RLNT 6 b e n h n h a n T H A p h a n l a n it trieu chting t u y n h i e n khi co cac RLN that nang CO the la n g u y e n n h a n g a y ngat, cac b i o i CO tim macii va t h a m ehi d o t t u a b^nh rtiian T H A vi vay Iam Holter dien tim de ehan d o a n la het siic can thiet [2,4].
RLNT a b e n h rUian T H A da d u p e nhieu tae gia n u o c ngoai nghien ctiu n h u n g tai Viet N a m c h u a con it n g h i e n Ctiu ve v a n d e nay, vi vay chiing toi n g h i e n ctiu de tai n a y riham m u c tieu.
TAP CHl TIM MACH HOC VIET NAM - S6 54 - 2010
'MSM
Danh gia nguy co roi loan nhip tim a berth nhan tang huye't ap guyen phat.
DUI TirCfNG VA PHIflfNG PHAP NGHIEN ClfU:
Nhom nghien ciiu gom 365 b^nh nhan THA nguyen phat theo tieu chu&i chan doan cua JNC 7 va 85 nguoi binh thudng. Cae doi tupng dupc tham kham lam sang, dien tim, sieu am tim, Holter dien tim 24 gio.
Dac dilm chung cua cac doi tu'O'ng nghien ciJu:
Nghien ciiu theo phuang phap tie'n ctiu eat ngang c6 so sanh doi ehie'u vai nhom chiing.
Xu ly so'lieu bang chuong trinh phan mem SPSS 11.5 for window.
K^t qua nghien cu'u
N h o m T h o n g so
Tuoi (nam)
Gioi N a m
N u Chieu cao Can n a n g (kg)
BMI (kg/m2)
N h o m T H A (n = 365) 59,3 ± 8,4 319 (87,4%)
46 (12,6%) 1,62 ± 0,05 61,5 ± 7,6 23,4 ± 2 , 3
N h o m chiing (n = 85) 59,1 ± 8,6 73 (85,9%) 12 (14,1%) 1,61 ± 0,05 59,9 ± 6,4 23,0 ± 1,9
P
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 Ke't qua cho tha'y khong co su khac biet ve tuoi, gioi, chieu eao, can nang, ehi so' khoi eo the giiia nhom THA va nhom ehiing.
Thd'i gian phat hien benh va biin chu'ng tim cua nhom tang huyet ap n, %
T h o n g so
Thoi p h a t hien benh (nam) So BN p h a t hi§n b e n h > 5 n a m
Phi dai that trai EF < 50%
N M C T c u
T o n g (n = 365) 5,5 ± 4,5
140 144 42 36
%
59,1 ± 8,6 38,4 39,5 11,5 9,8
NGHIEN CLTU L A M SANG
Thai gian phat hien benh trung binh 5,5 nam, trong do so benh nhan phat hi?n benh tren 5 nam chiem 38,4%. Ton thucmg co quan dich: so benh nhan c6 PDTT la 144 (39,5%), 11,5% CO EF < 50%, NMCT cii 9,8%.
R6i loan nhjp tim v benh nhan tang huylt ap ' • ____^ N h o m
Thong so '^ '—-—____
So'luong NTT tren that 24 g i o So l u o n g NTT that 24 gio
N h o m T H A (n = 365) 148,7 ± 342 272,9 ± 708
N h o m c h u n g (n = 85) 44,6 ± 104,4
40,8 ± 1 5 4 P
< 0,001
<0,01 Roi l o a n nhip tren that
Ti le NTT tren that (n, %) Rung nhl (n, %) Con n h i p n h a n h tren that (n, %)
323 (88,5%) 31 (8,5%) 23 (6,3%)
50 (58,8%) 0 2 (2,4%)
< 0,001
>0,05 Roi loan nhip that
Ti le NTT that (n, %) Phan dp Lown
DpO Dp 1-2 Do 3-4
261 (71,5%) 104 (28,5%) 150 (41,1%) 111 (30,4%)
28 (32,9%) 57 (67,1%) 28 (32,9%)
0
< 0,001
< 0,001
>0,05
Nguy c c roi loan nhip tim 6" benh nhan tang huyet a p .
^ ^ ^ - . . ^ ^ ^ ^ T H A C a c t h o n g s o ~ - - v , . ^ ^
RLN tren that
RLN that C o K h o n g
Co K h o n g
Co n
323 42 261 104
%
88,5 11,5 71,5 28,5
K h o n g K
50 35 28 57
%
58,8 41,2 32,9 67,1
OR
5,4
5,1
95% a
3 , 1 - 9 , 2
3 , 1 - 8 , 4 P
< 0,001
< 0,001
THA la mpt ye'u to lam nguy co RLN tren that len 5,4 va RLN tha't len 5,1 voi p < 0,001.
TAP CHi TIM MACH HOC VIET NAM - SO 54 - 2010
Nguy c c r6i loan nhip tim a benh nhan tang huyet ap tudi > 60.
^ " " ^ ' " - - . . n L A t u o i > 6 0 Cac t h o n g so ^"""•--~^,^
RLN tren that
RLN that
RLN tha't phiic t^p C o K h o n g
Co K h o n g
C o K h o n g
Co n 157
12 133 36 66 103
%
92,9 7,1 78,7 21,3 39,1 60,9
K h o n g n 166
30 128
68 45 151
%
84,7 15,3 65,3 34,7 22,9 77,1
OR
2,4
1,97
2,2 95% CI
1,2 - 4,8
1,2 - 3,1
1,4 - 3,4 P
<0,01
< 0,005
< 0,001
O b | n h nhan THA co tuoi tren 60 lam tang nguy co RLN tren that len 2,4 lan, RLN that len 1,97 lan va RLN that phiic tap len 2,2 Ian.
Nguy CO' RLNT if benh nhan THA co thd'i gian m i c benh tren 5 nam.
^ " " " - - - - . . ^ T H A > 5 n a m Cac t h o n g so ^ ^ ^ - ^ , ^ ^
RLN tren that
RLN that
RLN that phiic t a p Co Khong
Co K h o n g
Co K h o n g
Co n 123
17 111 29 64 76
%
87,8 12,2 79,3 20,7 45,7 54,3
K h o n g n 200
25 150
75 47 178
%
88,9 11,1 66,7 33,3 20,9 79,1
OR
0,9
1,9
3,2 95% Cl
0,5 1,7
1,2 - 3,1
2 - 5 , 1 P
>0,05
<0,01
<
0,001 Benh nhan bi THA tren 5 nam la yeii to lam tang nguy ca RLN that Ien 1,9 lan va nguy eo RLN that phiic tap Ien 3,2 Ian so vai nhom eo thoi gian mac benh duoi 5 nam.
NGHItN Ciru LAMSANG
Nguy CW roi loan nhjp tim 6- benh nhan tang h u y i t a p c o POTT
^~~~~~-~^...,_^ T H A Cac thong so ^"~~^^._.___^
RLN tren that
RLN that
RLN tha't phiic tap Co IChong C o K h o n g Co K h o n g
Co PDTT n 138 6 123 21 72 72
%
95,8 4,2 84,5 14,6 50 50
K h o n g PDTT n 185 36 138 83 39 182
%
83,7 16,3 62,4 37,6 17,6 82,4
OR
4,5
3,5
4,7 9 5 % CI
1,8-10,9
2 , 1 - 6 , 1
2 , 9 - 7 , 5 P
< 0,001
< 0,001
< 0,001
PDTT la ye'u to nguy co lam tang RLN tren tha't len 4,5 Ian va RLN that len 3,5 Ian, dac biet lam tang nguy co RLN phiic tap len 4,7 Ian.
Nguy c c RLN tim a benh nhan THA co NMCT cu:
^~~~~~~-~JHA CO N M C T cu Cac thong so' ^''~~~^~-._,^_^
RLN tren that
RLN that C o Khong C o K h o n g Co K h o n g
Co n 36 0 32 4 24 12
%
100 0 88,9 11,1 66,7 33,3
K h o n g n 287 42 229 100 87 242
%
87,3 12,7 69,6 30,4 26,4 83,6
OR
3,5
5,6 95% CI
1 , 2 - 1 0
2 , 7 - 1 1 , 6 P
<0,01
< 0,001
THA CO NMCT cu l i n tang nguy CO RLN that va RLN that phiic tap len 3,5 deh 5,6 lan.
Nguy CO' roi loan nhjp tim dr benh nhan THA co EF < 50%
^ ~ ~ ~ " ^ ^ - J T l A CO EF < 5 0 % Cac thong so ^'^^--^.^^^^
RLN tren that C o K h o n g
Co n 41 1
%
97,6 2,4
K h o n g n 282 41
%
87,3 12,7
OR
6
95% CI
0 , 7 - 4 4 P
<0,05
TAP CHl TIM MACH HOC VIET NAM - SO 54 - 2010
RLN that
RLN tha't phiic tap Co Khong Co Khong
41 1 37 5
97,6 2,4 88,1 11,9
220 103 74 249
68,1 31,9 22,9 77,1
19,2
24,9 2,6 -141
9,4 - 65
< 0,001
< 0,001
O ber* nhan THA eo EF < 50% lam tang nguy eo RLN tren tiia't, RLN that va RLN tiia't phiic tap len 6; 19,2 va 24,9 lan.
BAN L U A N
Dac d i i m cua nhom nghien ciru : Nhom nghien ciiu gom 365 benh nhan THA theo tieu ehuan ctia JNC 7 va 85 nguoi binh thuong. Stj khac biet ve tuoi, gioi, chieu cao, can nang, chi so'khoi CO the giua nhom THA va nhom chiing khong CO y nghia tho'ng ke. Thoi gian mae benh THA trtmg binh ciia nhom nghien Cthi khoang 5,5 nam. Ti le berth nhan co giam siic co bop ea tim (EF < 50%) chi chiem 11,5%. So benh nhan eo NMCT cii chiem 9,8%, ti le PDTT tren sieu am tim la 39,5%. Nghien ctiu etia Dao Thu Giang va cong su nhan thay 6 benh nhan THA ty le PDTT (40,7%), suy tim (17,3%), benh TMCTCB (14,8%) [5].
Rot loan nhjp tim & benh nhan tang huyet ap:
Nhiing nghien ciiu ve RLN tim 6 benh nhan THA deu nhan tha'y tan xua't gap cac RLN tim va miic do phiic tap cua cac RLN o beitii nhan THA cao hon rat nhieu so voi nhom chting. Vai tro ctia HATT va HATTr doi voi RLNT cting eo
khac nhau. Mammarella A nhan tha'y ne'u chi THA tam thu don dpe thi ti le gap cac roi loan nhip tha't phiic tap gap 6 17,1%
con neu THA tam truong don doc thi tan xua't gap cae RLN nay la 31,5%. Tang ca huye't ap tam thu va tam truong thi ti le nay la 20,4% [6].
Ke't qua nghien eiiu cho thay RLN tren that ehie'm 88,5% va RLN that ehie'm 71,5%. Ti le nay cao hon ro ret so vai nhom chting (58,8% va 32,9%) vdi p <
0,001. Benh nhan THA co so NTT tren tiia't 24 gio va NTTT 24 gio cao hon nhom chiing lan luat la 148,7 (342 va 272,9 (708 so vai 44,6 ( 104,4 va 40,8 ( 154; p < 0,01 den 0,001. John B Kostis (1992) nhan thay NTTT 24 gio 6 nhom THA la 412 ± 1612 cao hem so vcd rtiiom ehiing 179 ± 479, su khae biet co y nghia voi p < 0,05 [7].
Giuseppe Schillaci va eong sir thue hien mot nghien ctiu (1996) tren 126 berth nhan bi benh THA khong duoc dieu tri.
Cac tac gia nlian tha'y ti le co NTT that 6 benh nhan THA la 70,6%, trong do co 35,7 % Lown do 3-5, NTT tiiat 24 gio 250
± 664 [8]. Nhu vay ti le gap cac RLN that.
NGHIEN CU'U LAM SANG
RLN that phiic tap va .\Tr that 24 gio tuong duong voi nghien ciiu ciia chiing toi (71,5%; 30,4% va NTT that 24 gio 272,9 ( 708). Kaan Kulan (1998) nghien ciiu 68 b^nh nhan THA, tuoi trung binh la 52 va 30 nguoi binh thuong. Kei qua la ti le benh nhan co NTT that 6 nhom THA 94,1% va nhom chiing 73%. Nhom THA co Lown 1 la 14 (20,6%), Lown 2 la 23 (33,8%), Lown tit dp 3 tro len la 27 (39,7%) va 6 nhom chiing lan lupt la 13 (43%), 6 (20%) va 3 (10%) [9]. Galinier (2002) nghign ciiu Holter di|n tim cho 209 benh nhan THA gap NTT tren tha't trung binh 24 gio la 312 { 207 va NTTT la 757 ( 2664, trong do Lown dp 1-2 ehie'm 51,9; Lown dp 3 - 5 ehie'm 34,4% [4]. Nhu vjy so lupng NTT tren that va N i l 1 24 gio 6 nghien cihi nay cao hon so voi nghien ciiu cua chiing toi nhung tan xua't gap cac RLNT phiic tap thi tuong duong voi nghien ciiu ciia chiing toi (34,4%, so vdi 30,4%).
Rung nhi va con nhip nhanh tien that cung la nhihig roi loan nhip thuong g?p 6 benh nhan THA. Trong nghien Cliu nay chiing toi gap 8,5% co con rung nhi 6 nhom THA con 6 nhom chiing thi khong CO truong hpp nao. Ti le gap con nhip nhanh tren that ngin 6 benh nhan THA la 6,3% cao hon so voi nhom chiing 2,4%. Paolo Verdecchia (2003) theo doi 16 nam, 2482 benh nhan THA nguyen phat khong dupc dieu tri ta't ca deu la nhip xoang, loai trit benh van tim, benh mach vanh, hpi chiing dan truyen som, cuong chiic nang tiiyen giap, benh phoi man tinh. Ti 1? gap rung nhl 0,46% b|nh nhan
trong mpt nam. Nhom xua't hien rung nhi CO tuoi, HA tam thu 24 gio, ducmg kinh nhi trai cao hon nhom khong bi rung nhi [10].
Nguy CO RLN tim 6 benh nhan THA Co che' gay roi loan nhip tim ra't phiic tap, CO the do roi loan hinh thanh xung dpng, roi loan dan truy&i hoac ca hai. Nguyen nhan gay roi loan nhip tim thucmg gap la nhung ton thucmg thuc the tren tim nhu nhoi mau co tim, viem CO tim, PDTT... va nhiing benh toan than nhu benh ly tuym giap, benh ly co quan ho ha'p, roi loan dien giai va thang b3ng kiem toan... Cac bang chiing ve vai tro cua TFIA vol roi loan nhip tim ngay cang dupc khang dinh qua cac nghien ciiu 6 tren the' gioi. Khi tim hieu ve moi lien quan giiia THA va roi l o ^ nhip tim hau he't cac tac gia deu nhan thay THA la mpt ye'u to nguy co quan trpng gay roi loan nhip tim [11]. Trong nghien ciiu cua chiing toi THA lam tang 5,4 lan nguy co roi loan nhip tren tha't (OR - 5,4; 95% CI:
3,1-9,2; p < 0,001) va 5,1 lan nguy co roi loan nhip that (OR = 5,1; 95%, O : 3,1-8,4;
p < 0,001).
Thoi gian mSc benh THA cang dai thi ton thucmg co quan dich cang nang ne hon, dac biet la ton thucmg tim. Nghien Cliu ciia chiing toi nhan tha'y thoi gian bi THA tren 5 nam lam tang nguy co RLN that len 1,9 lan va nguy co RLN that phiic tap len 3,2 lan.
Tuoi cao la mpt yeii to Iam tang RLN tim a nguoi binh thuong cung nhu benh
TAPCHITIMMACH HOC VIET NAM - SO 54 - 2010
nhan THA. Trong nghien ciiu nay chiing toi nhan tha'y 6 benh nhan THA tuoi tren 60 lam tang nguy co RLN tren tha't len 2,4 Ian, RLN that len 1,97 lan va RLN that phiic tap len 2,2 lan. David Siegel (1990) nghien ciiu RLN tim 6 nam gioi bi THA nhan tha'y 6 tuoi 60-70 nguy co mac RLN that ding nhu RLN that phiic tap tang 3,4 lan so voi dp tuSi 35-59 [12]. Giuseppe SchUlad (1996) nghien cihi o 126 benh nhan THA nguyen phat khong dupc dieu tri. Tac gia nhan thay nguy co RLN that Lown tir dp 2 tro Ien 6 nhom benh nhan 1cm hem 60 tuoi tang len 10,4 Ian ( OR = 10,4; 95% CI: 2 , 4 ^ [13].
Nguy CO RLN tim 6 benh nhan THA co PBTT:
O nhung benh nhan bi benh THA, PDTT la nguy ca quan trpng gay RLNT.
Nghien cihi Framingham nhan thay 6 benh nhan bi b?nh THA co PDTT ti le hi vong sau 12 nam la 59%; tang 3 lan nguy CO mac benh dpng mgch vanh trong 14 nam; tang 6 lan dpt tix a nam va 3 Ian 6 nii. Ne'u tang moi 50g/m2 khoi lupng co that trai thi nguy co tir vong do tim mach tang 1,73 lan 6 nam va 2,12 lan 6 nii. Tan xua't va miic dp RLN tha't co Uen quan voi miic dp PDTT, ne'u tang 1 mm chieu day vach lien that hoac thanh sau tha't trai thi tang 2 de'n 3 lan tan xua't xua't hien RLN that va RLN that phiic tap. 6 benh nhan THA CO PDTT thi nguy co RLN tren that, rung nhi tang gap 3 lan so voi THA chua CO PDTT [14]. Galinier M. va cpng su nhan tha'y THA co PDTT thi nguy co RLN that tang gap 6 Ian so voi nhom THA chua
CO PDTT [4]. SchiUad (1996) nhan thay 6 benh nhan THA co PDTT lam tang 4,2 lan nguy CO RLN tim ttr Lown 2 tro len ( OR - 4,2; 95%CI: 1,5-16) [13].
Ke't qua nghien ciiu ciia chiing toi cho tha'y PDTT lam tang nguy co RLN tren that len 4,5 lan (OR = 4,5; 95% CI:
1,8-10,9; p < 0,001) va lam tang tan xua't RLN thai len 3,5 Ian so voi nhom THA ma chua co PDTT (OR = 3,5; 95% CI: 2,1- 6,1; p < 0,001). Khong nhiing the PDTT con lam tang nguy co RLN that phiic tap (Lown 3-4) len 4,7 lan (OR - 4,7; 95% Ct 2,9-7,5; p < 0,001). Nhu vay trong Iam sang viec dieu tri THA va su lua chpn cac thuoc dieu tri ha ap co tac dung lam giam PDTT nhu lie che' men chuyen, chen be ta.. .cho benh nhan THA co PDT la rat can thie't de giam nguy co RLNT.
Nguy CO RLN tim o benh nhan THA co NMCT cu va EF < SO.
NMCT va suy tim 6 benh nhan THA cimg voi PDTT lam bieri doi ca'u tnic va chiic nang ciia tim, lam thay doi chuyen hoa dan de'n lam tang nguy co gay RLN tim, dac biet la cac RLN phiic tap gop phan gay ra cac bie'n chiing, ti le tii vong chung ding nhu ti le tir vong do tim mach.
Trong nghien ciiu ciia chiing toi benh nhan THA co NMCT cu gap 100% co NTT tren that. NMCT 6 benh nhan THA lam tang nguy co RLN that Ien 3,5 Ian (95%, CI: 1,3-9; p < 0,005) va lam tang nguy co RLN that phiic tap Ien 5,6 lan (95% CI:
2,8-11; p< 0,001).
NGHIEN CUU LAM S A N G
Benh n h a n T H A CO EF < 50% lam tang n g u y CO RLN tren that Ien 6 lan (95%, Cl:
0,7-44; p < 0,05), dac biet Iam tang n g u y CO RLX that len 19,2 lan (95%, Cl: 2,6-141;
p < 0,001) va lam tang n g u y co RLX tha^
phiic t a p len 24,9 lan (95% Q : 9,4-65; p
< 0,001). Vester va cpng s u n h a n thay o b e n h nhan THA khi t h a m d o dien sinh ly CO R L \ ' tha't phiic tap chiic n a n g tam thu that trai giam m p t each ro ret (EF% giam 47 ± 18 so voi 71 ± 17 %) [15].
KET LUAR
Nghien ciiu Holter dien tim 24 gio tren 365 benh n h a n TFIA nguyen p h a t va 85 ngucri binh t h u o n g , chiing toi n i t ra ke't luan sau:
T H A la ye'u to n g u y co lam tang RLN tren t h a t len 5,4 lan va t a n g RLN tha't Ien 5,1 lan. Tuoi > 60 lam tang n g u y CO RLN tren that len 2,4 lan va RLN that len 1,97 lan, RLN tha't phiic tap len 2,2 Ian. Thoi gian p h a t hien b ? n h T H A tren 5 n a m la ye'u to n g u y co lam tang RLN that Ien 1,9 lan va RLN that p h i i c t a p len 3,2 Ian. TFiA co PDTT lam t a n g n g u y co RLN tren that, RLN that, RLN that phiic t a p len Ian lucrt la: 4 3 lan; 3,5 lan; 4,7 lain;
I T I A c o N M C T cii Iam t a n g n g u y CO RLN tha't len 3,5 lan, RLN tha't phiic tap Ien 5,6 Ian. T H A c6 EF < 50% Iam t a n g n g u y CO RLN tren that Ien 6 Ian, t a n g n g u y co RLN tha't len 19,2 lan, RLN tha't phiic tap len 24,9 Ian.
SUMMARY:
24-hour ambulatory electrocardiographic monitoring were analysed to assess cardiac arryth- mias in 365 hypertensive patients (HP) and 85 nomortensive (control group). Two groups were matched for age, sexand BMI. The results showed that: the hypertension increased the risk of supraventricular arrhythmias u p to 5.4, of ventricular arrhythmias up to 5.1. The age of over 60 increased the risk of supraventricular arrhythmias, ventricular arrhythmias, complex ventricular arrhythmias up to 2.4; 1.97; 22 respechvely The risk of ventricular arrhythmias, complex ven- tricular arrhythmias were shown to increase up to 1.9 and 3.2 in the HP group with the dura- tion of hypertension over 5 years. Left ventricular hypertrophy was found to increase the risk of supraventricular arrhythmias, ventricular arrhythmias, complex ventricular arrhythmias up to 4.5; 3.5 and 4.7. Old myocardial infarction increased the risk of ventricular arrhythmias u p to 3.5 and of complex ventricular arrhythmias up to 5.6. The risk of supraventricular arrhythmias, ventricular arrhythmias, complex ventricular arrhythmias were increased u p lo 6; 19.2 and 24.9 respectively in the HP group with LVEF < 50%.
TAP CHi TIM MACH HQC VIgT NAM - SO 54 - 2010
TAI UEU THAM KHAO
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