ТУРБУЛЕНТНОСТЬ РИТМА СЕРДЦА И МИКРОВОЛЬТНАЯ АЛЬТЕРНАЦИИ ЗУБЦА Т У БОЛЬНЫХ С ГИПЕРТРОФИЕЙ МИОКАРДА

To study peculiar features of heart rate turbulence (HRT) and microvolt T-wave alternations (mTWA) in patients with hypertrophic cardiomyopathy and arterial hypertension with the left ventricular hypertrophy (LVH), examined were 50 patients aged 40.6±18.3 years with hypertrophic cardiomyopathy (25 men and 25 women), 71 patients aged 59.2±10.9 years with arterial hypertension (34 men and 37 women), and 90 subjects aged 47.8±20.7 years (48 men and 42 women) free of cardiovascular diseases. The examination was carried out, which included collection of historical data, physical examination, echocardiography, and ECG Holter monitoring. During ECG Holter monitoring, mTWA and HRT were assessed. The turbulence onset (TO) and turbulence slope (TS) indices were calculated when assessing HRT. Based on the results of echocardiographic assessment, the patients with arterial hypertension were distributed into two following subgroups: subjects with LVH (14 men and 21 women aged 59.3±10.4 years) and patients without LVH (20 men and 16 women aged 59.1±11.4 years). The control group was divided into 2 subgroups, as well. Subgroup 1 (24 men and 26 women aged 38.6±20 years) was used for comparison with the hypertrophic cardiomyopathy subjects, Subgroup 2 (24 men and 16 women aged 59±16 years), for comparison with arterial hypertension subjects. Alterations of the first HRT were noted in 18% of patients with hypertrophic cardiomyopathy and 1 patient of control group (2%, p<0.05%). The analysis of mTWA parameters showed that the hypertrophic cardiomyopathy subjects were characterized by higher values of mTWA05:00 as compared with the control group. The correlation analysis in the patients with hypertrophic cardiomyopathy did not show significant correlation of mTWA indices with the width of the left ventricular (LV) myocardium, excluding mild negative correlation of the inter-ventricular septum width and mTWA100 in Lead II in FA 1/32 (rS=-0.320, p<0.05). Thus, the patients with hypertrophic cardiomyopathy as as opposed to control group are characterized by a higher occurrence of HRT disturbances (mainly, TO) and higher levels of mTWA recorded in early pre-morning hours. However, the correlation of the alterations observed with the LVH extent either was not revealed or was of the minimal extent. In patients with arterial hypertension and LVH, the HRT alterations were revealed more frequently than in control group (40% and 12.5%, respectively; p<0.05). The correlation analysis in the overall patient group with arterial hypertension (n=71) showed a slight positive correlation of TO with the posterior wall width (rS=0.376, p<0.05). The analysis of mTWA parameters showed significantly higher levels of mTWA05:00 (FA 1/8 and 1/32, Lead I) in the patients with arterial hypertension and LVH as compared with control group. Thus, the patients with LVH due to arterial hypertension and hypertrophic cardiomyopathy are characterized by a higher incidence of HRT alterations and higher levels of mTWA05:00 as opposed to the subjects free of cardiovascular diseases; however, the correlation of the above alterations with the LVH extent is either absent (mTWA05:00) or is minimal (TO).