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Determinants of ventricular ectopy in hypertensive cardiac hypertrophy
1Department of Internal Medicine, Ochsner Clinic, New Orleans, LA 70121.
Insights
In hypertensive patients, left ventricular hypertrophy (LVH) correlates with increased ventricular ectopy. Factors like age, LVH severity, and cardiac function influence ectopy frequency and severity.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Left ventricular hypertrophy (LVH) in arterial hypertension is linked to ventricular ectopy.
- Understanding the cardiovascular mechanisms is crucial for risk stratification.
Purpose of the Study:
- To investigate the relationship between LVH severity and ventricular ectopy in hypertensive patients.
- To identify cardiovascular factors associated with the frequency and complexity of ventricular ectopy.
Main Methods:
- Echocardiographic monitoring (24-hour and 2-D guided M-mode) was used in 53 hypertensive patients with mild to moderate LVH.
- Patients were categorized based on ectopy severity (Lown's class) and complexity (monofocal vs. complex).
Main Results:
- Patients with more severe ectopy (Lown's class II-IV) were older and showed greater increases in left ventricular mass and function indices.
- A subgroup with complex ventricular ectopy exhibited enhanced left ventricular mass, volume, and contractility compared to those with simple ectopy.
Conclusions:
- Ventricular ectopy frequency and severity in hypertensive patients with LVH are influenced by age, LVH severity, chamber volume, and cardiac contractility.
- Further research is needed to determine if ectopy patterns predict sudden death risk in this population.
Abstract:
Left ventricular hypertrophy in arterial hypertension has repeatedly been documented to trigger or aggravate ventricular ectopy. To determine cardiovascular mechanisms underlying ventricular ectopy, we examined 53 hypertensive patients with mild to moderate nondilated left ventricular hypertrophy by 24-hour echocardiographic monitoring and two-dimensional (2-D)-guided M-mode echocardiography. Patients with more severe ectopy (Lown's class II to IV) were older and had greater increases in left ventricular mass, ejection fraction, velocity of circumferential fiber shortening, end-diastolic volume index, and left ventricular stroke work than patients with less severe ectopy (Lown's class 0 to I). Left ventricular mass, end-diastolic diameter, stroke volume, stroke work, ejection rate, velocity of circumferential fiber shortening, and fractional fiber shortening were enhanced in a subgroup with complex ventricular ectopy (multiform or paired premature ventricular beats or runs of ventricular tachycardia) when compared with a subgroup matched with respect to age, sex, body surface area, and mean arterial pressure, which had uniform monofocal ventricular beats occurring with a frequency of less than 10/hr only. Our data indicate that the frequency and severity of ventricular ectopy in patients with essential hypertension is determined by age, severity of left ventricular hypertrophy, chamber volume, and indices of contractility and pump function. Whether or not the pattern of ventricular ectopy will identify hypertensive patients with left ventricular hypertrophy who are at increased risk of sudden death remains to be determined.