PROGNOSTIC VALUE OF VENTRICULAR ARRHYTHMIAS IN SYSTEMIC HYPERTENSION

Objective Hypertensive left ventricular hypertrophy is associated with an increased risk of arrhythmias and mortality. However, no clinical study has demonstrated a significant relationship between ventricular arrhythmias and mortality in systemic hypertension. Design and methods To evaluate the prognostic value of arrhythmogenic markers, we includ ed, prospectively, 214 hypertensive patients aged (mean +/- SD) 59.1 /- 12.8 years, without symptomatic coronary disease, myocardial infarc tion, systolic dysfunction or electrolyte disturbances. At inclusion, a 12-lead electrocardiogram (ECG) with QT dispersion calculation, a 24 h Holter ECG (204 patients) with Lown classification of ventricular a rrhythmias, echocardiography (reliable in 187 patients) and a signal-a veraged ECG (125 patients) with ventricular late potentials were recor ded. Results At baseline, echocardiographic left ventricular hypertrop hy was found in 63 patients (33.7%). Non-sustained ventricular tachyca rdia (Lown class IVb) was recorded in 33 patients (16.2%) and late pot entials in 27 patients (21.6%). After a mean follow-up of 42.4 +/- 26. 8 months, all-cause mortality was 11.2% (24 patients); 17 patients die d of cardiac causes (7.9%); of these, nine (4.2%) died suddenly. In un ivariate analysis, age, Lown class IVb and a QT dispersion > 80 ms wer e significantly related to global, cardiac and sudden death (P < 0.01) . The left ventricular mass index was related to cardiac mortality (P = 0.002). In multivariate analysis, only Lown class IVb was an indepen dent predictor of global and cardiac mortality, increasing the risk of global death 2.6-fold (95% confidence interval 1.2-6.0) and cardiac d eath 3.5-fold (95% confidence interval 1.2-9.7). Conclusion In hyperte nsive patients the presence of non-sustained ventricular tachycardia h as prognostic value. (C) Rapid Science Publishers ISSN 0263-6352.