Highlights
- •High Lown's classes were more frequently observed in the presence of LVH.
- •Mean QTc was directly correlated with indexed LV mass.
- •SDNN was lower in patients with CKD compared to patients with preserved renal function.
- •DM, CKD, prolonged QTc, and SDNN < 96 ms were independent predictors of CV death at 2 years follow-up.
Abstract
Background
The prognostic role of left ventricular remodeling and renal function in elderly hypertensive
patients has been so far scarcely investigated.
Aims
We assessed the impact of left ventricular geometry and renal function on 24 h-Holter electrocardiogram (ECG) recordings and outcome in elderly hypertensive patients.
Methods
We enrolled 251 asymptomatic hypertensive elderly patients (>65 year-old). Left ventricular remodeling was evaluated by 2-D echocardiogram. Lown's
class, mean QTc and standard deviation of all normal R–R intervals (SDNN) were assessed
by 24-h Holter-ECG recordings. Data on all-cause and cardiovascular mortality were
collected for 2 years.
Results
Mean age was 76.2 ± 11.4 years. High Lown's classes were more frequently observed in the presence of left ventricular
hypertrophy (LVH) (57.3% vs. 23.7%; p < 0.001). Mean QTc was 444.8 ± 34.8 ms and resulted directly correlated with indexed left ventricular mass (r = 0.228; p = 0.001). Patients with Chronic Kidney Disease (CKD) showed lower SDNN as compared with
those with preserved renal function (92.02 ± 36.11 ms vs. 103.84 ± 33.96 ms, respectively; p = 0.017). At 2 years, all-cause and cardiovascular mortality rates were 38.0% and 21.1%, respectively.
Diabetes mellitus (HR: 2.40; 95% C.I.1.16 to 4.99; p = 0.019), CKD (HR: 2.22; 95% C.I.1.10 to 4.52; p = 0.028), prolonged QTc (HR: 2.18; 95% C.I.1.07 to 4.41; p = 0.030) and SDNN < 96 ms (HR: 1.98; 95% C.I.1.03 to 4.13; p = 0.048) were independent predictors of cardiovascular death at 2 year follow-up.
Conclusions
CKD and left ventricular remodeling predicted altered ventricular batmotropism. Diabetes,
CKD, heart rate variability and QTc are important predictors of cardiovascular death
in elderly hypertensive patients.
Keywords
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Article info
Publication history
Published online: January 15, 2016
Accepted:
January 3,
2016
Received in revised form:
November 30,
2015
Received:
September 3,
2015
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
