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[Arrhythmia risk and noninvasive markers in hypertensive left ventricular hypertrophy]
Bahri Akdeniz1, Sema Güneri, Ozer Badak
1Dokuz Eylül Universitesi Tip Fakültesi Kardiyoloji Anabilim Dali, Inciralti-Izmir. bahri.akdeniz@deu.edu.tr
Insights
Hypertension with mild to moderate left ventricular hypertrophy (LVH) increases the risk of potentially malignant ventricular arrhythmias (PMVA). Noninvasive markers like QTcd and late potentials identify patients at higher risk, not autonomic function or blood pressure levels.
Area of Science:
- Cardiology
- Electrophysiology
- Hypertension Research
Context:
- Severe left ventricular hypertrophy (LVH) in hypertensive patients is linked to malignant ventricular arrhythmias and sudden death.
- The arrhythmia risk associated with mild to moderate LVH remains uncertain.
- Hypertension is a prevalent condition, and understanding associated cardiac risks is crucial for patient management.
Purpose:
- To investigate the risk of ventricular arrhythmias in hypertensive patients with mild to moderate LVH.
- To evaluate the role of noninvasive arrhythmia markers in assessing this risk.
- To determine the influence of ambulatory blood pressure on arrhythmia risk.
Summary:
- This study included 99 hypertensive patients, classifying them into hypertrophic (LVH(+), n=43) and non-hypertrophic (LVH(-), n=56) groups.
- Potentially malignant ventricular arrhythmias (PMVA) were significantly more frequent in the LVH(+) group (20.9% vs. 6.5%).
- Increased QTcd and ventricular late potentials were associated with higher PMVA incidence in hypertensive patients with mild to moderate LVH.
Impact:
- Identifies mild to moderate LVH as a risk factor for ventricular arrhythmias in hypertensive patients.
- Highlights the utility of QTcd and late potentials as noninvasive markers for arrhythmogenic risk stratification.
- Suggests that arrhythmogenicity in this population is not primarily related to autonomic dysregulation or ambulatory blood pressure.
Objective:
Several studies have evidenced that hypertensive patients with severe left ventricular hypertrophy have an increased incidence of malignant ventricular arrhythmia and sudden death. However arrhythmia risk in mild to moderate hypertrophy is uncertain. This study aims to investigate the risk of ventricular arrhythmias in hypertensive patients with mild to moderate hypertrophy and evaluate the role of noninvasive arrhythmia markers and ambulatory blood pressures.
Methods:
Ninety-nine hypertensive patients (35 male, mean age 57.3 +/- 9.6) without coronary heart disease were included the study. All subjects underwent an echocardiography for measurement of LV mass index (LVMI) and were classified in two groups; hypertrophic (LVH(+) n:43) and nonhypertrophic (LVH(-) n:56). Ambulatory blood pressure monitoring, 24 hour ECG, signal averaged ECG, and 12 lead ECG were performed in each group seeking to identify the arrhythmogenic risk.
Results:
Holter ECG showed that 20.1% patients had Lown class II and 12.1% patients had Lown class IVa-IVb arrhythmia (potentially malignant ventricular arrhythmia; PMVA). PMVA incidence was significantly higher in hypertrophic groups (20.9%) compared to nonhypertrophic groups (6.5%) (p < 0.05). Ambulatory systolic and diastolic blood pressures were similar in PMVA(+) and PMVA(-) patients. At least two parameters of ventricular late potentials were significantly higher in LVH(+) group (25.7%) compared to LVH(-) group (4.9%) (p < 0.01). HRV parameters were not different between two groups. QTcd was significantly increased in LVH(+) than in LVH(-) patients (54.1 +/- 16.7 vs. 47.5 +/- 17.7 ms) (p < 0.05) The frequency of PMVA was significantly higher in increased QTcd compared to normal QTcd (24.3%-3.4%; p < 0.01) and LP(+) patients (16.2%) compared to LP(-) patients (8.7%; p < 0.05).
Conclusion:
Our data suggest that hypertension may be associated with high risk of PMVA in patients with mild to moderate LVH particularly in presence of LP and QTcd > 50 ms. QTcd and at least 2 factors of LP were increased in mild to moderate LVH. Arrhythmogenecity does not seem to be related with autonomic dysregulation and ambulatory blood pressure level in hypertensive patients.