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[Prognostic value of ventricular arrhythmia in hypertensive patients]
M Galinier1, S Balanescu, J Fourcade
1Service de cardiologie CHU Rangueil, Toulouse.
Insights
In hypertensive patients, non-sustained ventricular tachycardia identified by 24-hour Holter monitoring predicts increased risk of cardiac death. This finding highlights the prognostic value of ventricular arrhythmias in managing hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Electrophysiology
Context:
- Hypertensive left ventricular hypertrophy (LVH) increases arrhythmia and mortality risk.
- Previous studies lacked clear links between ventricular arrhythmias and mortality in systemic hypertension.
Purpose:
- To assess the prognostic significance of arrhythmogenic markers in systemic hypertension.
- To determine if ventricular arrhythmias predict mortality in hypertensive patients.
Summary:
- The study analyzed 214 hypertensive patients, evaluating ECG, 24-hour Holter, echocardiography, and signal-averaged ECG.
- Non-sustained ventricular tachycardia (Lown IVb) and QT dispersion were common.
- Multivariate analysis revealed Lown class IVb as an independent predictor of global and cardiac mortality.
Impact:
- Non-sustained ventricular tachycardia on 24-hour Holter monitoring is a significant prognostic indicator in hypertensive patients.
- This research clarifies the link between ventricular arrhythmias and mortality in systemic hypertension.
- Findings can inform risk stratification and management strategies for hypertensive individuals.
Objective:
Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. However, no clinical study demonstrated a significant relation between ventricular arrhythmias and mortality in systemic hypertension.
Design And Methods:
To evaluate the prognostic value of arrhythmogenic markers in systemic hypertension, we included between 1987 and 1993. 214 hypertensive patients, 59.1 +/- 12.8 years old, without symptomatic coronary disease, myocardial infarction, systolic dysfunction, electrolyte disturbances or antiarrhythmic therapy. At inclusion, an ECG, a 24 h Holter ECG (204 patients) with Lown classification of ventricular arrhythmias, an echocardiography (reliable in 187 patients) with left ventricular mass index and ejection fraction calculation, a SAECG (125 patients, enrolled after 1988) with ventricular late potentials (LP) were recorded. QT interval dispersion (QTd) was calculated on 12 leads standard ECG and LVH was appreciated.
Results:
At baseline echocardiographic LVH was recorded in 63 patients (33.7%) with normal ejection fraction (75 +/- 7.4%). Non-sustained ventricular tachycardia (Lown IVb) was found in 33 pts (16.2%) and LP in 27 patients (21.6%). After a mean follow up of 42.4 +/- 26.8 months, all-cause mortality was 11.2% (24 patients); 17 patients died of cardiac causes (7.9%); of these 9 patients (4.2%) died suddenly. In univariate analysis, age, strain pattern of LVH, advanced Lown classes and abnormal QT dispersion (> 80 ms) were significantly related to global, cardiac and sudden death (p < or = 0.01). Left ventricular mass index was closely related to cardiac mortality (p = 0.002). LP failed to predict mortality. In multivariate analysis, only Lown class IVb was an independent predictor of global and cardiac mortality, increasing the risk of global death 2.6 fold [1.2-6.0] (CI 95%) and the risk of cardiac death 3.5 fold [1.2-9.7] (CI 95%).
Conclusions:
In hypertensive patients the presence of non-sustained ventricular tachycardia on 24 h Holter has a prognostic value.