title: Valvular regurgitations may increase risk of arrhythmias in Nigerians with hypertensive heart failure.
abstract: BACKGROUND
  Hypertensive heart disease (HHD) is the commonest cause of sudden cardiac death among Nigerians. A high frequency and early onset of valvular regurgitations (VHD) in hypertensives, and greater concentric hypertrophy are also common in that population.
  
  
  OBJECTIVE
  To further investigate the relationship between VHD and cardiac arrhythmias and their correlates seen in the hypertensive spectrum and to test the hypothesis that VHD predisposes to cardiac arrhythmias in hypertensive heart failure (HHF). HHF patients (n = 14), HHD patients n = 23, and normotensive controls (n = 9) all underwent 24 h electrocardiogram Holter monitoring as well as two-dimensional and Doppler echocardiography. Participants in each patient category were classified according to the presence and severity of VHD or its absence (NVHD).
  
  
  RESULTS
  There were statistically significant differences in the mean supraventricular tachycardia (SVT) (P < 0.001 analysis of variance; ANOVA), the mean and median frequency of ventricular tachycardia episodes (P < 0.02 ANOVA), and couplets (P = 0.0002 ANOVA) between groups. HHF-VHD always had more SVT (81/24 versus 4.4/24 h; P = 0.016) and ventricular arrhythmias 69/24 versus 34/24 h (P < 0.02) than HHF-NVHD. Multivalvular regurgitations (three or more valves), higher left ventricular mass index (g/m2) [274 (24) versus 191(19); P < 0.001 ANOVA], and lower ejection fraction (EF; %) [29(3) versus 53(14)] in HHF-VHD were arrhythmogenic. Mean ventricular tachycardia/triplet frequency/24 h were HHF-VHD 69, HHF-NVHD 39, HHD-VHD 0.3, HHD-NVHD 6, and controls 0.2 (P < 0.02 ANOVA). Compared with 35% (10/27) of all VHD, 15.7% (3/19) of all NVHD participants had nonsustained ventricular tachycardia. The number of regurgitant valves was positively correlated with the frequency of the Lown class of the arrhythmias 0-IVB (r = 0.42, P = 0.003) and to ventricular tachycardia (r = 0.3, P = 0.04) (both n = 46).
  
  
  CONCLUSIONS
  Left ventricular hypertrophy (LVH) increased arrhythmias. But multivalvular regurgitations predisposes to greater SVT and complex ventricular arrhythmias, especially in HHF. Low EF and concentric LVH are correlates.
authors.affiliation: Division of Cardiology, Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. adeajayi@aol.com
authors.forename: Olufemi E
authors.initials: OE
authors.lastname: Ajayi
authors.forename: Adesuyi A L
authors.initials: AA
authors.lastname: Ajayi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D006332:Cardiomegaly / Q000453:epidemiology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018450:Disease Progression; D015150:Echocardiography, Doppler; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology*