title: Impact of left ventricular remodeling and renal function on 24h-ECG recordings and cardiovascular outcome in elderly hypertensive patients.
abstract: BACKGROUND
  The prognostic role of left ventricular remodeling and renal function in elderly hypertensive patients has been so far scarcely investigated.
  
  
  OBJECTIVE
  We assessed the impact of left ventricular geometry and renal function on 24h-Holter electrocardiogram (ECG) recordings and outcome in elderly hypertensive patients.
  
  
  METHODS
  We enrolled 251 asymptomatic hypertensive elderly patients (>65year-old). Left ventricular remodeling was evaluated by 2-D echocardiogram. Lown's class, mean QTc and standard deviation of all normal R-R intervals (SDNN) were assessed by 24-h Holter-ECG recordings. Data on all-cause and cardiovascular mortality were collected for 2years.
  
  
  RESULTS
  Mean age was 76.2±11.4years. High Lown's classes were more frequently observed in the presence of left ventricular hypertrophy (LVH) (57.3% vs. 23.7%; p<0.001). Mean QTc was 444.8±34.8ms and resulted directly correlated with indexed left ventricular mass (r=0.228; p=0.001). Patients with Chronic Kidney Disease (CKD) showed lower SDNN as compared with those with preserved renal function (92.02±36.11ms vs. 103.84±33.96ms, respectively; p=0.017). At 2years, all-cause and cardiovascular mortality rates were 38.0% and 21.1%, respectively. Diabetes mellitus (HR: 2.40; 95% C.I.1.16 to 4.99; p=0.019), CKD (HR: 2.22; 95% C.I.1.10 to 4.52; p=0.028), prolonged QTc (HR: 2.18; 95% C.I.1.07 to 4.41; p=0.030) and SDNN<96ms (HR: 1.98; 95% C.I.1.03 to 4.13; p=0.048) were independent predictors of cardiovascular death at 2year follow-up.
  
  
  CONCLUSIONS
  CKD and left ventricular remodeling predicted altered ventricular batmotropism. Diabetes, CKD, heart rate variability and QTc are important predictors of cardiovascular death in elderly hypertensive patients.
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
authors.forename: Agata
authors.initials: A
authors.lastname: Buonacera
authors.affiliation: Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, University of Catania, Cannizzaro Hospital, Department of Clinical and Experimental Medicine, Via Messina 829, 95126 Catania, Italy; Faculty of Medicine of Tunis, University Tunis El Manar, 15 Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia.
authors.forename: Marouane
authors.initials: M
authors.lastname: Boukhris
authors.affiliation: Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, University of Catania, Cannizzaro Hospital, Department of Clinical and Experimental Medicine, Via Messina 829, 95126 Catania, Italy.
authors.forename: Salvatore D
authors.initials: SD
authors.lastname: Tomasello
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Campagna
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cilia
authors.affiliation: CNR IBIM, Via Petrara c/o Ospedali Riuniti, 89100 Reggio Calabria, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Marca
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Terranova
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Pisano
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Mastrosimone
authors.affiliation: Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, University of Catania, Cannizzaro Hospital, Department of Clinical and Experimental Medicine, Via Messina 829, 95126 Catania, Italy.
authors.forename: Alfredo R
authors.initials: AR
authors.lastname: Galassi
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Stancanelli
authors.affiliation: Institute for Experimental Medical Research, Oslo University Hospital, Ullevål PB 4956 Nydalen, NO-0424, Oslo, Norway.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cataliotti
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy. Electronic address: malatino@unict.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Malatino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006339:Heart Rate; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D020257:Ventricular Remodeling
chemical_list: D003404:Creatinine
keywords: Chronic kidney disease; Heart rate variability; Left ventricular hypertrophy; QTc interval; Ventricular arrhythmias