IMPAIRED LEFT-VENTRICULAR FILLING IN HYPERTENSIVE LEFT-VENTRICULAR HYPERTROPHY AS A MARKER OF THE PRESENCE OF AN ARRHYTHMOGENIC SUBSTRATE

Objective-To assess the prevalence of ventricular late potentials and ventricular tachycardia in hypertensive subjects with left ventricular hypertrophy and to study their relation to clinical characteristics. Setting-Teaching and general hospital in Padua. Methods-107 hypertensi ve subjects with echocardiographic signs of left ventricular hypertrop hy were studied with signal averaged electrocardiography and 24 hour B olter monitoring. Signal averaged electrocardiogram analysis was perfo rmed with high pass filters of 25 Hz, 40 Hz, and 80 Hz. Ventricular la te potentials were considered to be present if at least two determinan ts of the signal averaged electrocardiogram were abnormal in one of th e three filters. 70 normotensive subjects sewed as age matched control s. Results-25% (27) of the hypertensive subjects and 6% (four) of the controls showed late potentials on signal averaged electrocardiography (P < 0.0001). The hypertensive subjects with late potentials had a hi gher prevalence of ventricular tachycardia (33%, 9/27) than without la te potentials (13%, P = 0.035). Twenty nine per cent (31/107) of the h ypertensive subjects had an inversion of the early to atrial filling v elocity (EIA ratio < 1) on Doppler analysis of transmitral flow. Withi n this group the percentage of subjects with late potentials (55%, 17/ 31) and ventricular tachycardia (42%, 13/31) was much greater than tha t within the group of subjects without an inverted EIA ratio (13%, 10/ 76 (P < 0.0001) and 12%, 9/76 (P = 0.001) respectively). In a multivar iate analysis only the EIA ratio was related to the presence or absenc e of either late potentials (P 0.0001) or ventricular tachycardia (P 0 .0008). Both late potentials and ventricular tachycardia were unrelate d to left ventricular mass, geometry, and systolic performance. Conclu sions-A relation was found between the occurrence of ventricular tachy cardia and the presence of late potentials in hypertensive subjects wi th left ventricular hypertrophy. Impaired left ventricular filling was the main marker for the arrhythmogenic substrate present in this dise ase.