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Influence of the type and degree of left ventricular hypertrophy on the prevalence of ventricular arrhythmias in patients with hypertensive heart disease

Purpose: To investigate the correlation between the type and degree of left ventricular hypertrophy (LVH) and the prevalence of ventricular arrhythmias (VA) in hypertensive patients with LVH. Methods: A total of 192 hypertensive patients (87 men and 105 women) were divided into three groups according to type of LVH: concentric (relative wall thickness RWT >0.45 and interventricular septum/left ventricular posterior wall IVS/LVPW<1.3), eccentric (diameter LV in systoles>32 and RWT<0.45) and asymmetric (IVS/LVPW> 1.3). Each group was divided into subgroups according to the degree of LVH: mild (IVS or LVPW 11-12 mm), moderate (IVS or LVPW 13-14mm) and severe (IVS or LVPW ≥15 mm). Excluded were patients with congestive heart failure, known coronary disease, heart surgery, valvular diseases, previous myocarditis and hypertrophic obstructive cardiomyopathy in the absance of systemic hypertension, patients with diabetes mellitus, alcoholics, patients with mental disorders, those overusing non-antihipertensive drugs, patients with malignant or accelerated hypertension, and those that had suffered a stroke in the previous six months. Patients with cancer, abnormal electrolytes, anemia, cardiopulmonary diseases, serum creatinine >140 μmol/L and abnormal thyroid function were also excluded. In all subjects blood pressure was measured, electrocardiographic and echocardiographic data obtained and the prevalence of VA determined by Holter monitoring and bicycle ergometry. Results: The most frequent LVH type was the concentric (63%), followed by eccentric (28%) and asymmetric (9%). Severe LVH was found in 10% of patients. Patients with eccentric LVH had a significantly higher left ventricular mass index then those with concentric LVH (p=0.011). Patients with asymmetric LVH presented no significant difference in relation to the concentric and eccentric. Complex VA during Holter monitoring were identified in over 40% of patients. There was no statistically significant difference between groups in frequency of simple (p=0.757) and complex (p=0.657, p=0.819, p=0.617, for polytopic, pairs and ventricular tachycardia, respectively) VA. Increased prevalence of VA was found for the moderate and severe degree in all types. In the concentric type the difference was statistically significant for simple VA (p=0.042). Conclusion: There was no correlation between type of LVH and prevalence of VA. The severity of hypertrophy slightly contributes to a greater prevalence of the same. Asymmetric hypertrophy carries no increased risk.

hypertension; heart disease; left ventricular hypertrophy; ventricular arrhythmias

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