Nonsustained Ventricular Tachycardia as a Predictor of Cardiovascular Events in Black Men With Hypertensive Left Ventricular Hypertrophy.
OBJECTIVE: To determine the prognostic significance of asymptomatic nonsustained ventricular tachycardia in Black males with hypertensive left ventricular hypertrophy without apparent coronary artery disease. BACKGROUND: The Framingham study has demonstrated a higher incidence of cardiovascular mortality including sudden cardiac death in patients with hypertensive left ventricular hypertrophy. Several studies have demonstrated an increased incidence of complex ventricular arrhythmias in patients with left ventricular hypertrophy even in the absence of significant coronary artery disease. There are few long term data, however, regarding the cardiovascular morbidity and mortality associated with asymptomatic ventricular arrhythmias in Black males with essential hypertension and left ventricular hypertrophy. METHODS: Baseline 48 hour Holter monitoring was performed in 110 Black males with hypertensive left ventricular hypertrophy and the presence of nonsustained ventricular tachycardia; the occurrence and frequency of ventricular ectopy were recorded. The study end point was all cause mortality and cardiovascular morbidity (cerebrovascular accident, congestive heart failure, myocardial infarction, and new onset angina). RESULTS: In the 22 patients with nonsustained ventricular tachycardia there were a total of nine events compared to eight events in the 78 patients without nonsustained ventricular tachycardia. During a mean follow up period of 6.4Â+/-2.1 years, patients with hypertensive left ventricular hypertrophy and nonsustained ventricular tachycardia on baseline Holter electrocardiogram had an event rate of 41% compared with only 10% in patients without nonsustained ventricular tachycardia (p is less than 0.0001). Using a multivariate Cox proportional hazards model to adjust for age and left ventricular mass index the presence of nonsustained ventricular tachycardia was strongly and independently associated with increased all cause mortality and cardiovascular morbidity (relative risk 12.7, confidence interval 4.1-38.7; p is less than 0.0001). CONCLUSIONS: The presence of nonsustained ventricular tachycardia in hypertensive Black males with left ventricular hypertrophy is a strong and independent predictor of cardiovascular events. (c)2000 by Le Jacq Communications, Inc.
Greenberg
Michael D.
MD
Division of Cardiology, Department of Veterans Affairs Medical Center, Washington, DC.
Papademetriou
Vasilios
V
Narayan
Puneet
P
Kokkinos
Peter
P