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Morphologic left ventricular patterns and prevalence of high-grade ventricular arrhythmias in the normotensive and
A Mammarella1, M Paradiso, S Basili
1Department of Medical Therapy, University La Sapienza, Rome, Italy.
Insights
Systemic hypertension in the elderly increases cardiovascular disease risk. This study found hypertension, particularly diastolic, significantly elevates serious ventricular arrhythmias, suggesting cardiac structural changes, not just hypertrophy, are key.
Area of Science:
- Cardiology
- Geriatrics
- Hypertension Research
Background:
- Systemic hypertension is a primary risk factor for cardiovascular diseases in the elderly.
- Left ventricular hypertrophy (LVH), a common response to chronic pressure overload, is linked to sudden death and arrhythmias.
- Understanding the relationship between hypertension subtypes and ventricular arrhythmias is crucial for geriatric cardiovascular health.
Purpose of the Study:
- To compare the prevalence of serious ventricular arrhythmias in elderly hypertensive individuals versus normotensive controls.
- To investigate the role of left ventricular mass index (LVMI) in differentiating anatomic adaptations to various hypertension types.
- To explore the underlying mechanisms of arrhythmia development in hypertensive elderly patients.
Main Methods:
- Enrolled 378 untreated elderly subjects (≥65 years), including 203 hypertensive and 175 normotensive individuals.
- Utilized 12-lead electrocardiography, echocardiography (M-mode and B-mode), and 24-hour ambulatory electrocardiographic monitoring.
- Categorized hypertension into systolic, diastolic, and systolic-diastolic types and assessed LVMI.
Main Results:
- Serious arrhythmias (Lown classes ≥3) were significantly more prevalent in hypertensive groups (17.1% to 31.5%) compared to normotensive controls (6.8%).
- Diastolic hypertension showed the highest prevalence of serious arrhythmias (31.5%).
- Arrhythmia prevalence did not correlate with specific left ventricular morphologic patterns or LVMI, nor between hypertensive subgroups.
Conclusions:
- Hypertension, especially diastolic, is associated with a higher incidence of serious ventricular arrhythmias in the elderly.
- The findings suggest cardiac structural alterations due to hypertension, potentially cardiac fibrosis, are more critical for arrhythmia pathogenesis than electrophysiologic changes in hypertrophied muscle.
- Further research into hypertension-induced cardiac structural changes is warranted to understand and prevent ventricular arrhythmias in older adults.
Abstract:
In the elderly, systemic hypertension is the main risk factor for cardiovascular diseases. Left ventricular hypertrophy, the most common adaptation to chronic pressure overload, has been recognized as an independent risk factor for an increased incidence of sudden death and arrhythmic disturbances. This study compared the prevalence of serious ventricular arrhythmias in elderly individuals with uncomplicated hypertension and in normotensive age-matched controls, using left ventricular mass index (LVMI) to differentiate patterns of anatomic adaptation to systolic, diastolic, or systolic-diastolic hypertension. The study enrolled 378 consecutive untreated elderly subjects (> or = 65 years of age), without clinical evidence of heart failure; 203 were hypertensive and 175 were normotensive. Each participant underwent standard 12-lead electrocardiography, M-mode and B-mode echocardiography, and 24-hour ambulatory electrocardiographic monitoring. Serious, statistically significant arrhythmias (Lown classes > or = 3) were present in 6.8% of normal subjects versus 17.1% of individuals with systolic, 31.5% of those with diastolic, and 20.4% of participants with systolic-diastolic hypertension. Arrhythmias did not differ in terms of left ventricular morphologic patterns or LVMI or between subgroups of hypertensive patients. Our data support the hypothesis that the pathogenesis of arrhythmias is related not to the electrophysiologic derangement of hypertrophied muscle but, rather, to the effects of hypertension on the cardiac structure. Cardiac fibrosis, one of the deleterious events accompanying hypertension, may be the main substrate for ventricular arrhythmias.