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[Diastolic function parameters and atrial arrhythmias in patients with arterial hypertension]
C M Schannwell1, F C Schoebel, M Badiian
1Klinik für Kardiologie, Pneumologie und Angiologie, Medizinischen Klinik und Poliklinik B, Heinrich-Heine-Universität Düsseldorf.
Insights
Hypertension increases risk of atrial and ventricular arrhythmias, particularly with left ventricular hypertrophy. Diastolic dysfunction also contributes to atrial arrhythmias in hypertensive patients.
Area of Science:
- Cardiology
- Internal Medicine
- Electrophysiology
Context:
- Arterial hypertension is a significant risk factor for cardiovascular complications.
- Left ventricular (LV) hypertrophy and diastolic dysfunction are common sequelae of hypertension.
- Atrial and ventricular arrhythmias are serious complications that can arise from these cardiac changes.
Purpose:
- To investigate the relationship between left ventricular (LV) hypertrophy, diastolic function, and atrial arrhythmias in patients with arterial hypertension.
- To assess the risk of arrhythmias in hypertensive patients compared to a control group.
Summary:
- Hypertensive patients, even without LV hypertrophy, exhibit reduced diastolic function and exercise capacity.
- LV hypertrophy significantly increases the risk of LV arrhythmias, as evidenced by complex atrial arrhythmias, abnormal late potentials, and reduced heart rate variability.
- Atrial arrhythmias correlate strongly with LV diameter, morphological dimensions, and diastolic function, including isovolumetric relaxation time.
Impact:
- Findings highlight the increased risk of arrhythmias in hypertensive individuals due to LV structural and functional changes.
- The study emphasizes the distinct role of diastolic dysfunction in the development of atrial arrhythmias, separate from ventricular arrhythmias.
- This research provides valuable insights for risk stratification and management strategies for hypertensive patients prone to arrhythmias.
Objective:
To investigate in patients with arterial hypertension (HT) the extent of left ventricular (LV) hypertrophy and diastolic function in relation to atrial arrhythmias.
Patients And Methods:
In 112 hypertensive patients (40 women, 72 men; mean age 50 +/- 6.6 years) with a mean systolic blood pressure for the cohort of 170 +/- 5 mmHg, their first invasive coronary angiography was performed between July 1995 and October 1997 because of angina pectoris and/or an abnormal stress electrocardiogram. After excluding coronary heart disease LV dimensions and diastolic function were measured by echocardiography; in 59 of the 112 patients LV hypertrophy was demonstrated. In addition, long-term blood pressure monitoring, exercise and long-term electrocardiography, late-potential analysis and measurement of heart rate variability were undertaken. The control group consisted of 51 patients without arterial hypertension after exclusion of coronary heart disease.
Results:
Even in the hypertensive patients without LV hypertrophy diastolic LV function and ergometric exercise capacity were reduced. The risk of LV arrhythmias was significantly higher in patients with LV hypertrophy than those without and in the control group, as measured by the complexity of atrial arrhythmias (P < 0.001), the incidence of abnormal late potentials (P < 0.001) and reduction in heart rate variability (29.3 +/- 5.3 ms vs 47.8 +/- 12.1 ms vs 60.7 +/- 6.6 ms; P < 0.001). There were similar results regarding severe complex atrial arrhythmias (38.5 vs 15.0 vs 0%; P < 0.001). The incidence of atrial arrhythmias correlated with the LV diameter (r = 0.68, P < 0.001), LV morphological dimensions and diastolic function (isovolumetric relaxation time r = 0.44, P < 0.001) and the ratio of early to late diastolic inflow (r = 0.46; P < 0.001).
Conclusions:
Hypertensive patients have a higher risk of atrial and ventricular arrhythmias, depending on the degree of LV hypertrophy. But atrial arrhythmias, in contrary to ventricular arrhythmias, are also closely related to abnormalities in LV diastolic function.