[Arrhythmia risk and noninvasive markers in hypertensive left ventricular hypertrophy].
OBJECTIVE
Several studies have evidenced that hypertensive patients with severe left ventricular hypertrophy have an increased incidence of malignant ventricular arrhythmia and sudden death. However arrhythmia risk in mild to moderate hypertrophy is uncertain. This study aims to investigate the risk of ventricular arrhythmias in hypertensive patients with mild to moderate hypertrophy and evaluate the role of noninvasive arrhythmia markers and ambulatory blood pressures.


METHODS
Ninety-nine hypertensive patients (35 male, mean age 57.3 +/- 9.6) without coronary heart disease were included the study. All subjects underwent an echocardiography for measurement of LV mass index (LVMI) and were classified in two groups; hypertrophic (LVH(+) n:43) and nonhypertrophic (LVH(-) n:56). Ambulatory blood pressure monitoring, 24 hour ECG, signal averaged ECG, and 12 lead ECG were performed in each group seeking to identify the arrhythmogenic risk.


RESULTS
Holter ECG showed that 20.1% patients had Lown class II and 12.1% patients had Lown class IVa-IVb arrhythmia (potentially malignant ventricular arrhythmia; PMVA). PMVA incidence was significantly higher in hypertrophic groups (20.9%) compared to nonhypertrophic groups (6.5%) (p < 0.05). Ambulatory systolic and diastolic blood pressures were similar in PMVA(+) and PMVA(-) patients. At least two parameters of ventricular late potentials were significantly higher in LVH(+) group (25.7%) compared to LVH(-) group (4.9%) (p < 0.01). HRV parameters were not different between two groups. QTcd was significantly increased in LVH(+) than in LVH(-) patients (54.1 +/- 16.7 vs. 47.5 +/- 17.7 ms) (p < 0.05) The frequency of PMVA was significantly higher in increased QTcd compared to normal QTcd (24.3%-3.4%; p < 0.01) and LP(+) patients (16.2%) compared to LP(-) patients (8.7%; p < 0.05).


CONCLUSIONS
Our data suggest that hypertension may be associated with high risk of PMVA in patients with mild to moderate LVH particularly in presence of LP and QTcd > 50 ms. QTcd and at least 2 factors of LP were increased in mild to moderate LVH. Arrhythmogenecity does not seem to be related with autonomic dysregulation and ambulatory blood pressure level in hypertensive patients.
Dokuz Eylül Universitesi Tip Fakültesi Kardiyoloji Anabilim Dali, Inciralti-Izmir. bahri.akdeniz@deu.edu.tr
Bahri
B
Akdeniz
Sema
S
Güneri
Ozer
O
Badak
Ozgür
O
Aslan
Batuhan
B
Tamci
D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology*; D015415:Biomarkers; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D014421:Turkey / Q000453:epidemiology
D015415:Biomarkers