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Ventricular arrhythmias in aortic valve disease: a further marker of impaired left ventricular function
C Martínez-Useros1, P Tornos, J Montoyo
1Departamento de Medicina, Hospital General Vall d'Hebron, Barcelona, Spain.
Insights
Aortic valve disease frequently causes ventricular arrhythmias, particularly in aortic regurgitation. Left ventricular hypertrophy and function significantly correlate with arrhythmia severity and complexity in these patients.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Valvular Heart Disease
Background:
- Aortic valve disease (AVD) encompasses aortic stenosis and regurgitation, often leading to significant cardiac remodeling.
- Ventricular arrhythmias (VAs) are a known complication, but their specific relationship with AVD severity and left ventricular (LV) status requires further elucidation.
Purpose of the Study:
- To investigate the incidence and characteristics of VAs in patients with pure and severe AVD.
- To determine the correlation between VAs and clinical parameters, including LV hypertrophy (LVH) and function.
Main Methods:
- Prospective study of 120 stable AVD patients (aortic stenosis, regurgitation, or combined) without coronary lesions.
- Utilized electrocardiograms (ECGs), M-mode echocardiograms, and 24-hour ambulatory ECG (Holter monitoring).
- Correlated VA frequency and complexity with clinical and echocardiographic parameters.
Main Results:
- VAs were present in 92% of patients.
- Higher VA complexity correlated with more ventricular premature beats.
- Significant association found between ECG-detected LVH and arrhythmia severity (Ryan class).
- Inverse correlation between maximal hourly ventricular premature beats and LV ejection fraction.
- Aortic regurgitation patients exhibited significantly higher total and maximal hourly ventricular premature beats, more frequent pairs, and worse Ryan class.
Conclusions:
- AVD is associated with a high incidence of VAs.
- Aortic regurgitation presents a particularly high risk for VAs.
- LVH and impaired LV function are significantly related to the number and complexity of VAs in AVD patients.
Abstract:
One hundred and twenty stable patients with pure and severe aortic valve disease and without coronary lesions (aortic stenosis, 43 patients; aortic regurgitation, 45 patients; combined aortic stenosis and regurgitation, 32 patients) who had been submitted to haemodynamic studies were prospectively studied with standard electrocardiograms, M-mode echocardiograms, and 24-hour ambulatory electrocardiography (Holter recording). The frequency and complexity of ventricular arrhythmias were related to clinical parameters such as functional class, type of lesion and presence of syncope, and to parameters of left ventricular hypertrophy and function. Ventricular arrhythmias were present in 92% of patients. A high number of ventricular premature beats was directly correlated with parameters of complexity of the arrhythmia. A significant relation was found between electrocardiographic left ventricular hypertrophy and Ryan class (P less than 0.05), and an inverse relation between maximal number of ventricular premature beats in any hour and left ventricular ejection fraction (P less than 0.05). The group of patients with aortic regurgitation showed a higher total number of ventricular premature beats per 24 hours (P less than 0.001), a higher maximal number of these in any hour (P less than 0.01), a higher number of patients with pairs (P less than 0.001), and a higher number of patients in Ryan classes 3, 4A, 4B (P less than 0.01). This study shows a high incidence of ventricular arrhythmias in aortic valve disease, and especially in aortic regurgitation, with a significant relation between left ventricular hypertrophy and function, and number and complexity of arrhythmias.