Left Ventricular Hypertrophy
Left Ventricular Hypertrophy
Background: Arrhythmic patterns and left ventricular geometric adaptations to pressure overload were investigated in 76 patients with untreated borderline-to-moderate sustained essential hypertension studied by 2-dimensional and M-mode echocardiography, 12-lead, Holter, and signal-averaged electrocardiography, and ambulatory blood pressure monitoring.
Methods and Results: Sixty-two age- and sex-matched normal adults were chosen for data comparison. Hypertrophic hypertensive patients were subdivided into 2 subgroups: 44 patients with nocturnal blood pressure reduction (dippers) and 32 patients without it (nondippers). Common afterload and diastolic function indexes were found to be lower in combined nondipper and dipper groups, but only fractional shortening decreased in nondippers. The number of premature atrial and ventricular contractions per hour was high in dippers and nondippers, with no statistically significant differences between them; atrial and ventricular complex dysrhythmias were similar. Signal-averaged electrocardiography showed a prolonged P-wave duration in dipper and nondipper patients with high atrial volumes but no late ventricular potentials and no difference in quantitative P-wave analysis. Left atrial volumes, P-wave duration, and premature atrial contractions were found to be positively linked to left ventricular hypertrophy. In nondipper patients a linear correlation was observed between left atrial volume and P-wave duration, although supraventricular ectopic activity was connected to left atrial volume enlargement both in dipper and nondipper patients.
Conclusions:These data suggest that the nondipper pattern is not linked to a worse arrhythmogenic substrate; only atrial volume increase may be related to significant supraventricular activity and prolonged atrial activation in nondipper patients, but late ventricular potentials are uncommon in hypertrophic hypertensive patients.
Nondipper hypertensive patients (individuals with nocturnal blood pressure reduction) appear to have a higher left ventricular (LV) mass than dipper hypertensive patients (individuals without nocturnal blood pressure reduction). Previous studies demonstrated that ambulatory blood pressure monitoring (ABPM) is useful to detect echocardiographic LV hypertrophy (LVH) at higher grades in hypertensive individuals. Perspective studies demonstrated a good correlation between LVH and cardiovascular events in the Framingham population. For this reason, LVH is a common echocardiographic finding for which several risk factors can be identified. Obesity, age, sex, body size, blood pressure (BP) levels, blood viscosity, ischemic heart diseases, metabolic diseases, and sexual maturation were examined. LV geometry provides little prognostic information in individuals with normal LV mass and LVH; it has become an independent tool for the stratification of cardiovascular risk in arterial hypertension. Several studies evaluated cardiac function in hypertrophic hypertensive individuals, and there is some evidence of dysrhythmias to relate the arrhythmic status to geometric and hypertrophic patterns. This study, therefore, was designed to evaluate cardiac arrhythmias in relation to LV function, atrial activation, and volumes in hypertensive nondipper individuals with echocardiographic LVH compared with dipper normotensive and hypertensive patients.
Background: Arrhythmic patterns and left ventricular geometric adaptations to pressure overload were investigated in 76 patients with untreated borderline-to-moderate sustained essential hypertension studied by 2-dimensional and M-mode echocardiography, 12-lead, Holter, and signal-averaged electrocardiography, and ambulatory blood pressure monitoring.
Methods and Results: Sixty-two age- and sex-matched normal adults were chosen for data comparison. Hypertrophic hypertensive patients were subdivided into 2 subgroups: 44 patients with nocturnal blood pressure reduction (dippers) and 32 patients without it (nondippers). Common afterload and diastolic function indexes were found to be lower in combined nondipper and dipper groups, but only fractional shortening decreased in nondippers. The number of premature atrial and ventricular contractions per hour was high in dippers and nondippers, with no statistically significant differences between them; atrial and ventricular complex dysrhythmias were similar. Signal-averaged electrocardiography showed a prolonged P-wave duration in dipper and nondipper patients with high atrial volumes but no late ventricular potentials and no difference in quantitative P-wave analysis. Left atrial volumes, P-wave duration, and premature atrial contractions were found to be positively linked to left ventricular hypertrophy. In nondipper patients a linear correlation was observed between left atrial volume and P-wave duration, although supraventricular ectopic activity was connected to left atrial volume enlargement both in dipper and nondipper patients.
Conclusions:These data suggest that the nondipper pattern is not linked to a worse arrhythmogenic substrate; only atrial volume increase may be related to significant supraventricular activity and prolonged atrial activation in nondipper patients, but late ventricular potentials are uncommon in hypertrophic hypertensive patients.
Nondipper hypertensive patients (individuals with nocturnal blood pressure reduction) appear to have a higher left ventricular (LV) mass than dipper hypertensive patients (individuals without nocturnal blood pressure reduction). Previous studies demonstrated that ambulatory blood pressure monitoring (ABPM) is useful to detect echocardiographic LV hypertrophy (LVH) at higher grades in hypertensive individuals. Perspective studies demonstrated a good correlation between LVH and cardiovascular events in the Framingham population. For this reason, LVH is a common echocardiographic finding for which several risk factors can be identified. Obesity, age, sex, body size, blood pressure (BP) levels, blood viscosity, ischemic heart diseases, metabolic diseases, and sexual maturation were examined. LV geometry provides little prognostic information in individuals with normal LV mass and LVH; it has become an independent tool for the stratification of cardiovascular risk in arterial hypertension. Several studies evaluated cardiac function in hypertrophic hypertensive individuals, and there is some evidence of dysrhythmias to relate the arrhythmic status to geometric and hypertrophic patterns. This study, therefore, was designed to evaluate cardiac arrhythmias in relation to LV function, atrial activation, and volumes in hypertensive nondipper individuals with echocardiographic LVH compared with dipper normotensive and hypertensive patients.
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