Linkerventrikelhypertrofie op het ecg

Beschouwing

Samenvatting

Op uw spreekuur verschijnt een 57-jarige man van wie bekend is dat hij hypertensie en een intermediair cardiovasculair risicoprofiel heeft. U laat een ecg maken, waarop een sinusritme zichtbaar is. Er zijn ook aanwijzingen voor een linkerventrikelhypertrofie. Bij lichamelijk onderzoek constateert u geen afwijkende bevindingen; zo is er geen hartgeruis en ziet u ook geen uitgesproken links-rechts bloeddrukverschil. Wat moet u met deze ecg-bevindingen en wat zijn de prognostische consequenties en mogelijke behandelingen?

Literartur

  1. 1.
    Bacharova L, Schocken D, Estes EH, Strauss D. The role of ECG in the diagnosis of left ventricular hypertrophy. Curr Cardiol Rev 2014;10:257-61.Google Scholar
  2. 2.
    Katholi RE, Couri DM. Left ventricular hypertrophy: major risk factor in patients with hypertension: update and practical clinical applications. Int J Hypert 2011;495349.Google Scholar
  3. 3.
    Edhouse J, Thakur RK, Khalil JM. ABC of clinical electrocardiography. Conditions affecting the left side of the heart. BMJ 2002;324:1264-7.Google Scholar
  4. 4.
    Kumpusalo E, Lappi J, Takala J. Prevalence of left ventricular hypertrophy in Finnish primary health care hypertensive patients. J Hum Hypertens 2001;15:255-8.Google Scholar
  5. 5.
    Lozano JV, Redon J, Cea-Calvo L, Fernández-Pérez C, Navarro J, Bonet A, et al. Left ventricular hypertrophy in the Spanish hypertensive population. The ERICA-HTA study. Rev Esp Cardiol 2006;59:136-42.Google Scholar
  6. 6.
    NHG. NHG-Standaard Cardiovasculair risicomanagement (eerste herziening). Huisarts Wet 2012;55:14-28.Google Scholar
  7. 7.
    Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation 2009:119:e235-40.Google Scholar
  8. 8.
    Pewsner D, Jüni P, Egger M, Battaglia M, Sundström J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ 2007;335:711.Google Scholar
  9. 9.
    Levy D, Labib SB, Anderson KM, Christiansen JC, Kannel WB, Castelli WP. Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation 1990;81:815-20.Google Scholar
  10. 10.
    Lee DK, Marantz PR, Devereux RB, Kligfield P, Alderman MH. Left ventricular hypertrophy in black and white hypertensives. Standard electrocardiographic criteria overestimate racial differences in prevalence. JAMA 1992;267:3294-9.Google Scholar
  11. 11.
    Muisesan ML, Salvetti M, Di Castelnuovo A, Paini A, Assanelli D, Costanzo S, et al. Obesity and ECG left ventricular hypertrophy. J Hypertens 2017;35:162-9.Google Scholar
  12. 12.
    Cuspidi C, Facchetti R, Sala C, Bombelli M, Tadic M, Grassi G, et al. Do combined electrocardiographic and echocardiographic markers of left ventricular hypertrophy improve cardiovascular risk estimation? J Clin Hypertens 2016;18:846-54.Google Scholar
  13. 13.
    Patel N, O’Neal WT, Whalen SP, Soliman EZ. Electrocardiographic left ventricular hypertrophy predicts atrial fibrillation independent of left ventricular mass. Ann Noninvasive Electrocardiol 2017;22:1-5.Google Scholar
  14. 14.
    Martinez MA, Sancho T, Armada E, Rubio JM, Antón JL, Torre A, et al. Prevalence of left ventricular hypertrophy in patients with mild hypertension in primary care: impact of echocardiography on cardiovascular risk stratification. Am J Hypertens 2003;16:556-63.Google Scholar
  15. 15.
    Kahan T, Bergfeldt L. Left ventricular hypertrophy in hypertension: its arrhythmogenic potential. Heart 2005;91:250-6.Google Scholar
  16. 16.
    Kannel WB, Dannenberg AL, Levy D. Population implications of electrocardiographic left ventricular hypertrophy. Am J Cardiol 1987;60:851-931.Google Scholar
  17. 17.
    Brown DW, Giles WH, Croft JB. Left ventricular hypertrophy as a predictor of coronary heart disease mortality and the effect of hypertension. Am Heart J 2000;140:848-56.Google Scholar
  18. 18.
    Desai CS, Ning H, Lloyd-Jones DM. Competing cardiovascular outcomes associated with electrocardiographic left ventricular hypertrophy: the atherosclerosis risk in communities study. Heart 2012;98:330-4.Google Scholar
  19. 19.
    Verdecchia P, Reboldi G, Di Pasquale G, Mazzotta G, Ambrosio G, Yang S, et al. Prognostic usefulness of left ventricular hypertrophy by electrocardiography in patients with atrial fibrillation (from the Randomized Evaluation of Long-Term Anticoagulant Therapy Study). Am J Cardiol 2014;133:669-75.Google Scholar
  20. 20.
    Estes EH, Zhang ZM, Li Y, Tereshchenko LG, Soliman EZ. Individual components of the Romhilt-Estes left ventricular hypertrophy score differ in their prediction of cardiovascular events: the atherosclerosis risk in communities (ARIC) study. Am Heart J 2015;170:1220-6.Google Scholar
  21. 21.
    Verdecchia P, Porcellati C, Reboldi G, Gattobigio R, Borgioni C, Pearson TA, et al. Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation 2001;104:2039-44.Google Scholar
  22. 22.
    Larsen CT, Dahlin J, Blackburn H, Scharling H, Appleyard M, Sigurd B, et al. Prevalence and prognosis of electrocardiographic left ventricular hypertrophy, ST segment depression and negative T-wave; the Copenhagen City Heart Study. Eur Heart J 2002;23:315-24.Google Scholar
  23. 23.
    Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J 2001;141:334-41.Google Scholar
  24. 24.
    Jorgensen PG, Jensen JS, Marott JL, Jensen GB, Appleyard M, Mogelvang R. Electrocardiographic changes improve risk prediction in asymptomatic persons age 65 years or above without cardiovascular disease. J Am Coll Cardiol 2014;64:898-906.Google Scholar
  25. 25.
    De Lemos JA, Ayers CR, Levine B, deFilippi CR, Wang TJ, Hundley WG, et al. Multimodality strategy for cardiovascular risk assessment: performance in 2 population-based cohorts. Circulation 2017;135:2119-32.Google Scholar
  26. 26.
    Soliman EZ, Ambrosius WT, Cushman WC, Zhang ZM, Bates JT, Neyra JA, et al. Effect of intensive blood pressure lowering on left ventricular hypertrophy in patients with hypertension: SPRINT (systolic blood pressure intervention trial). Circulation 2017;136:440-50.Google Scholar
  27. 27.
    Okin RB, Devereux RB, Harris KE, Jern S, Kjeldsen SE, Julius S, et al. Regression of electrocardiographic left ventricular hypertrophy is associated with less hospitalization for heart failure in hypertensive patients. Ann Int Med 2017:147:311-9.Google Scholar
  28. 28.
    Levy D, Salomon M, D’Agostino RB, Belanger AJ, Kannel WB. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation 1994;90:1786-93.Google Scholar
  29. 29.
    Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA 2004; 292:2343-9.Google Scholar
  30. 30.
    Bang CN, Devereux RB, Okin PM. Regression of electrocardiographic left ventricular hypertrophy or strain is associated with lower incidence of cardiovascular morbidity and mortality in hypertensive patients independent of blood pressure reduction – A LIFE review. J Electrocardiol 2014;47:630-5.Google Scholar
  31. 31.
    Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, et al. Prognostic significance of left ventricular mass change during treatment in hypertension. JAMA 2004;292:2350-6.Google Scholar
  32. 32.
    Okin PM, Wachtell K, Devereux RB, Harris KE, Jern S, Kjeldsen SE, et al. Regression of electrocardiographic left ventricular hypertrophy and decreased incidence of new-onset atrial fibrillation in patients with hypertension. JAMA 2006;296:1242-8.Google Scholar
  33. 33.
    Wachtell K, Okin PM, Olsen MH, Dahlöf B, Devereux RB, Ibsen H, et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive therapy and reduction in sudden cardiac death: the LIFE study. Circulation 2007;116:700-5.Google Scholar
  34. 34.
    Franz IW, Tönnesmann U, Müller JF. Time course of complete normalization of left ventricular hypertrophy during long-term antihypertensive therapy with angiotensin converting enzyme inhibitors. Am J Hypertens 1998;11:631-9.Google Scholar
  35. 35.
    Ferrara LA, De Simone G, Pasanisi F, Mancini M. Left ventricular mass reduction during salt depletion in arterial hypertension. Hypertension 1984;6:755-9.Google Scholar
  36. 36.
    Arroll B, Beaglehole R. Does physical activity lower blood pressure: a critical review of the clinical trials. J Clin Epid 1992:45:439-47.Google Scholar
  37. 37.
    Becker HF, Jerrentrup A, Ploch T, Grote L, Penzel T, Sullivan CE, et al. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003;107:68-73.Google Scholar
  38. 38.
    Fagard RH, Celis H, Thijs L, Wouters S. Regression of left ventricular mass by antihypertensive treatment: a meta-analysis of randomized comparative studies. Hypertension 2009;54:1084-91.Google Scholar
  39. 39.
    Klingbeil AU, Schneider M, Martus P, Messerli FH, Schmieder RE. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003;115:41-6.Google Scholar
  40. 40.
    Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37:2315-81.Google Scholar
  41. 41.
    Alkema M, Spitzer E, Soliman O, Loewe C. Multimodality imaging for left ventricular hypertrophy severity grading: a methodological review. J Cardiovasc Ultrasound 2016;24:257-67.Google Scholar
  42. 42.
    Ringoir L, Widdershoven JW, Pedersen SS, Keyzer JM, Pop VJ. Symptoms associated with an abnormal echocardiogram in elderly primary care hypertension patients. Neth Heart J 2014;22:234-9.Google Scholar
  43. 43.
    Authors/Task Force members, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. 2014 ESC guidelines on diagnosis and management of hypertrophy cardiomyopathy. Eur Heart J 2014;35:2733-79.Google Scholar
  44. 44.
    Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology. Eur Heart J 2013;34:2159-219.Google Scholar
  45. 45.
    Bekkers SCAM, Brunner-La Rocca HP. Elderly primary care hypertension patients – who to refer to echocardiography? Neth Heart J 2014;22:231-3.Google Scholar

Copyright information

© Bohn Stafleu van Loghum is een imprint van Springer Media B.V., onderdeel van Springer Nature 2018

Authors and Affiliations

  1. 1.Postdoctoraal onderzoeker in opleiding tot huisartsAfdeling huisartsgeneeskunde, Academisch Medisch CentrumAmsterdamNederland
  2. 2.Huisarts en huisarts-opleider AMCMedisch Centrum SeinhorstHilversumNederland
  3. 3.CardioloogAfdeling cardiologie, VU Medisch CentrumAmsterdamNederland

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