Morphologic left ventricular patterns and prevalence of high-grade ventricular arrhythmias in the normotensive and hypertensive elderly |
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Authors: | Antonio Mammarella MD Michele Paradiso MD Stefania Basili MD Antonio De Matteis MD Cristiano M Cardarello MD Manuela Di Franco MD Lucia Donnarumma MD Giancarlo Labbadia MD Vincenzo Paoletti MD |
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Institution: | (1) Department of Medical Therapy, University “La Sapienza”, Rome, Italy;(2) Viale dei Primati Sportivi, 54, 1-00144 Rome, Italy |
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Abstract: | In the elderly, systemic hypertension is the main risk factor for cardiovascular diseases. Left ventricular hypertrophy, the
most common adaptation to chronic pressure overload, has been recognized as an independent risk factor for an increased incidence
of sudden death and arrhythmic disturbances. This study compared the prevalence of serious ventricular arrhythmias in elderly
individuals with uncomplicated hypertension and in normotensive age-matched controls, using left ventricular mass index (LVMI)
to differentiate patterns of anatomic adaptation to systolic, diastolic, or systolic-diastolic hypertension. The study enrolled
378 con-secutive untreated elderly subjects (≥65 years of age), without clinical evidence of heart failure; 203 were hypertensive
and 175 were normotensive. Each participant underwent standard 12-lead electrocardiography, M-mode and B-mode echocardiography,
and 24-hour ambulatory electrocardiographic monitoring. Serious, statistically significant arrhythmias (Lown classes ≥3) were
present in 6.8% of normal subjects versus 17.1% of individuals with systolic, 31.5% of those with diastolic, and 20.4% of
participants with systolic-diastolic hypertension. Arrhythmias did not differ in terms of left ventricular morphologic patterns
or LVMI or between subgroups of hypertensive patients. Our data support the hypothesis that the pathogenesis of arrhythmias
is related not to the electrophysiologic derangement of hypertrophied muscle but, rather, to the effects of hypertension on
the cardiac structure. Cardiac fibrosis, one of the deleterious events accompanying hypertension, may be the main substrate
for ventricular arrhythmias. |
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Keywords: | hypertensive elderly ventricular arrhythmias left ventricular mass myocardial fibrosis |
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