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Heart rate variability in left ventricular hypertrophy
M K Mandawat1, D R Wallbridge, S D Pringle
1Department of Medical Cardiology, Royal Infirmary, Glasgow.
Insights
Left ventricular hypertrophy significantly reduces heart rate variability, indicating impaired cardiac autonomic function. This relationship, particularly with left ventricular mass index, may increase sudden death risk.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Cardiac Imaging
Background:
- Left ventricular hypertrophy (LVH) and strain are linked to increased cardiac morbidity and mortality.
- Impaired cardiac autonomic function, measured by heart rate variability (HRV), predicts sudden death post-myocardial infarction.
Purpose of the Study:
- To investigate the impact of left ventricular hypertrophy on heart rate variability.
- To explore the relationship between left ventricular mass and HRV.
Main Methods:
- Studied 154 patients with LVH (hypertension or aortic valve disease) and 36 controls.
- Measured HRV using 24-hour Holter recordings (non-spectral methods).
- Assessed left ventricular mass index (LVMI) and fractional shortening via echocardiography.
Main Results:
- Patients with LVH exhibited higher LVMI and significantly reduced HRV compared to controls (P < 0.001).
- A strong inverse correlation was found between HRV and LVMI (r = -0.478, P < 0.001).
- LVMI was identified as the primary determinant of HRV in multivariate analysis.
Conclusions:
- HRV is markedly reduced in LVH patients due to hypertension or aortic valve disease.
- A continuous inverse relationship exists between HRV and LVMI.
- Diminished cardiac autonomic function in LVH may underlie sudden cardiac death mechanisms.
Background:
Electrocardiographic left ventricular hypertrophy and strain are associated with increased cardiac morbidity and mortality. Impaired cardiac autonomic function, assessed non-invasively by spontaneous heart rate variability on Holter monitoring, is associated with an increased risk of sudden death after myocardial infarction.
Aim:
To study the effect of left ventricular hypertrophy on heart rate variability.
Patients:
36 controls and 154 patients with left ventricular hypertrophy (94 with hypertension and 60 with aortic valve disease).
Setting:
Tertiary referral centre.
Methods:
Heart rate variability was measured on 24 h Holter recordings by non-spectral methods. Left ventricular mass index and fractional shortening were measured by echocardiography.
Results:
Patients with left ventricular hypertrophy had a higher left ventricular mass index (P < 0.001) and reduced heart rate variability (P < 0.001) compared with those of the controls. A continuous inverse relation was apparent between heart rate variability and left ventricular mass index (r = -0.478, P < 0.001). Heart rate variability was not affected by age, the presence of coronary artery disease in patients with left ventricular hypertrophy, or beta blocker treatment for hypertension. Multivariate analysis showed that left ventricular mass index is the most important determinant of heart rate variability.
Conclusion:
Heart rate variability is significantly reduced in patients with left ventricular hypertrophy secondary to hypertension or aortic valve disease. A continuous inverse relation exists between heart rate variability and left ventricular mass index. Impaired cardiac autonomic function in left ventricular hypertrophy may contribute to the mechanism of sudden death.