CORRELATION OF SIGNAL AVERAGED ECG PARAMETERS WITH LEFT VENTRICULAR MASS INDEX IN PATIENTS WITH SYSTEMIC ARTERIAL HYPERTENSION
Background: Signal averaged ECG is a high-resolution electrocardiography which detects ventricular late potentials in patients susceptible to ventricular arrhythmias. Ventricular late potentials are identified on the basis of three parameters detected on signal averaged ECG. This study was planned to determine the correlation of signal averaged ECG parameters with left ventricular mass index in hypertensive patients. Methods: Sixty-four patients with systemic arterial hypertension were enrolled in the study. Patients with acute or old myocardial infarction, diabetes mellitus, cerebrovascular accident, heart failure, structural heart disease, bundle branch block and cardiomyopathies were excluded. Holter monitors (DMS 300 4L) were used to obtain 3 channel signal averaged ECG recording. CardioScan premium luxury software was used for analysis of ventricular late potentials. Results: There were 49 (76.6%) males and 15 (23.4%) female patients (n=64) with mean age of 60Â±11.83 years. Eleven patients (17.2%) had ventricular late potentials whereas 53 (82.8%) were without them. The mean values for filtered QRS complex, low amplitude signals, root mean square voltage, noise and left ventricular mass index were 108.52Â±23.63 ms, 28.81Â±20.78 ms, 92.17Â±51.02 Âµv, 0.29Â±0.26 Âµv and 140.48Â±68.26 g/m2 respectively. Left ventricular mass index was significantly and positively correlated with filtered QRS complex (p<0.001) and low amplitude signals (p=0.03) whereas the correlation with root means square voltage was not significant (p=0.84). Left ventricular mass index had significant and positive correlation with ventricular late potentials (p=0.009). Conclusion: Patients with higher left ventricular mass index are at greater risk of developing ventricular late potentials which are reflective of ventricular arrhythmias. In hypertensive patients with increased left ventricular mass index the arrhythmogenesis seems to be more related to duration of the cardiac signal as compared to its voltage.
Keywords: Ventricular late potentials, signal averaged ECG, systemic arterial hypertension, left ventricular mass index
Pak J Physiol 2018;14(1):19â€“22
2. Matsuzaki A, Yoshioka K, Amino M, Shima M, Hashida T, Fujibayashi D, et al. Usefulness of continuous 24-hour ventricular late potential to predict prognosis in patients with heart failure. Tokai J Exp Clin Med 2014;39(3):128â€“36.
3. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159â€“219.
4. Yiu KH, Tse HF. Hypertension and cardiac arrhythmias: a review of the epidemiology, pathophysiology and clinical implications. J Hum Hypertens 2008;22:380â€“8.
5. Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Gunson K, Jui J, et al. Electrocardiographic predictors of sudden cardiac death in patients with left ventricular hypertrophy. Ann Noninvasive Electrocardiol 2013;18(3):225â€“9.
6. Radulescu D, Stoicescu L, Buzdugan E, Donca V. Patterns of left ventricular remodeling among patients with essential and secondary hypertension. Rev Med Chil 2013;141:1520â€“7.
7. Sultana R, Sultana N, Rashid A, Rasheed SZ, Ahmed M, Ishaq M, et al. Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension. J Ayub Med Coll Abbottabad 2010;22(4):155â€“8.
8. Kahan T, Bergfeldt L. Left ventricular hypertrophy in hypertension: its arrhythmogenic potential. Heart 2005;91(2):250â€“6.
9. Santangeli P, Infusino F, Sgueglia GA, Sestito A, Lanza GA. Ventricular late potentials: a critical overview and current applications. J Electrocardiol 2008;41(4):318â€“24.
10. Rabbani MU, Gupta PR, Zaheer MS, Ashraf MU. A study on ventricular late potentials by signal averaged electrocardiogram in myocardial infarction patients. Ind Med Gaz 2014;CXLVII(12):449â€“52.
11. Chatterjee S, Bavishi C, Sardar P, Agarwal V, Krishnamoorthy P, Grodzicki T, et al. Meta-Analysis of left ventricular hypertrophy and sustained arrhythmias. Am J Cardiol 2014;114(7):1049â€“52.
12. Rudy Y. Noninvasive electrocardiographic imaging of arrhythmogenic substrates in humans. Circ Res 2013;112(5):863â€“74.
13. Shenasa M, Shenasa H, El-Sherif N. Left ventricular hypertrophy and arrhythmogenesis. Card Electrophysiol Clin 2015;7(2):207â€“20.
14. Breithardt G, Cain ME, el-Sherif N, Flowers NC, Hombach V, Janse M, et al. Standards for analysis of ventricular late potentials using high-resolution or signal-averaged electrocardiography: a statement by a task force committee of the European Society of Cardiology, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol 1991;5(17):999â€“1006.
15. Palatini P, Maraglino G, Accurso V, Sturaro M, Toniolo G, Dovigo P, et al. Impaired left ventricular filling in hypertensive left ventricular hypertrophy as a marker of the presence of an arrhythmogenic substrate. BMJ 1995;73(3):258â€“62.
16. Akdeniz B, GÃ¼neri S, Badak O, Aslan O, Tamci B. Arrhythmia risk and noninvasive markers in hypertensive left ventricular hypertrophy. Anadolu Kardiyol Derg 2002;2(2):121â€“9.
17. Schillaci G, Verdecchia P, Borgioni C, Ciucci A, Zampi I, Battistelli M, et al. Association between persistent pressure overload and ventricular arrhythmias in essential hypertension. Hypertension. 1996;28(2):284â€“9.
18. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991;114(5):345â€“52.
19. Bayes-Genis A, Guindo J, Vinolas X, Tomas L, Elosua R, Duran I, et al. Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension and their influences on prognosis. Am J Cardiol 1995;76(13):54Dâ€“59D.
20. WojszwiÅ‚Å‚o A, Åoboz-GrudzieÅ„ K, Jaroch J. Signal averaged ECG in different patterns of left ventricular hypertrophy and geometry in hypertension. Kardiol Pol 2003;58(5):335â€“43.
21. Perings C, Hennersdorf M, Vester EG, Strauer BE. Arrhythmia risk in left ventricular hypertrophy. Z Kardiol 2000;89(Suppl 3):36â€“43.
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