Impaired heart rate variability and increased ventricular ectopic activity in patients with left ventricular hypertrophy

Mandawat, Mahendra K.; Wallbridge, David; Pringle, Stuart D.; Riyami, Abdulla; Latif, Shahid; Macfarlane, Peter W.; Lorimer, A. R.; Cobbe, Stuart M.

doi:10.1016/s0022-0736(94)80088-x

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…On the other hand, lower values of low- and high-frequency power of HRV were observed in hypertensive patients with left ventricular hypertrophy than in controls, while ultralow- and very-low-frequency components were similar in the groups (Petretta et al, 1995). Left ventricular hypertrophy is a well known risk indicator, and HRV has been shown to be inversely related to left ventricular mass index (Mandawat et al, 1994, 1995; Petretta et al, 1995). However, not all studies have confirmed this finding (Perkiömäki et al, 1996).…”

Section: Heart Rate Variability In Risk Evaluationmentioning

confidence: 99%

Heart Rate Variability and Non-Linear Dynamics in Risk Stratification

Perkiömäki¹

2011

Front. Physio.

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The time-domain measures and power–spectral analysis of heart rate variability (HRV) are classic conventional methods to assess the complex regulatory system between autonomic nervous system and heart rate and are most widely used. There are abundant scientific data about the prognostic significance of the conventional measurements of HRV in patients with various conditions, particularly with myocardial infarction. Some studies have suggested that some newer measures describing non-linear dynamics of heart rate, such as fractal measures, may reveal prognostic information beyond that obtained by the conventional measures of HRV. An ideal risk indicator could specifically predict sudden arrhythmic death as the implantable cardioverter-defibrillator (ICD) therapy can prevent such events. There are numerically more sudden deaths among post-infarction patients with better preserved left ventricular function than in those with severe left ventricular dysfunction. Recent data support the concept that HRV measurements, when analyzed several weeks after acute myocardial infarction, predict life-threatening ventricular tachyarrhythmias in patients with moderately depressed left ventricular function. However, well-designed prospective randomized studies are needed to evaluate whether the ICD therapy based on the assessment of HRV alone or with other risk indicators improves the patients’ prognosis. Several issues, such as the optimal target population, optimal timing of HRV measurements, optimal methods of HRV analysis, and optimal cutpoints for different HRV parameters, need clarification before the HRV analysis can be a widespread clinical tool in risk stratification.

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Section: Heart Rate Variability In Risk Evaluationmentioning

confidence: 99%

Heart Rate Variability and Non-Linear Dynamics in Risk Stratification

Perkiömäki¹

2011

Front. Physio.

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Cardiac function after orthotopic liver transplantation and the effects of immunosuppression: A prospective randomized trial comparing cyclosporin (Neoral) and tacrolimus

Therapondos

Flapan

Dollinger

et al. 2002

Liver Transplantation

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There are several case reports in the literature that describe cardiac complications in the first few weeks after orthotopic liver transplantation (OLT) in patients receiving tacrolimus as their primary immunosuppressive therapy. In this study, we investigated the cardiac function of patients on tacrolimus (T) compared with those on cyclosporin (C) (Neoral; Novartis, Basel, Switzerland) immunosuppression, after OLT, in a prospective randomized trial. We randomized 40 adult patients with cirrhosis to either T or C with azathioprine and prednisolone immunosuppression and followed up on them for 3 months after OLT. All had detailed clinical, biochemical, electrocardiographic and echocardiographic assessments at regular intervals. Abnormalities in cardiac function were common after OLT and significant deterioration in left ventricular diastolic function was demonstrable up to 3 months in both patient groups. Cardiac function was similar in the T and C arms and no significant electrocardiographic differences were observed, although reduced heart rate variability (HRV) and higher mean serum brain natriuretic peptide (BNP) levels were identified in the T group. The percentage increase in posterior wall thickness was higher in the T group. Cardiac dysfunction as shown by worsening echocardiographic measures of left ventricular diastolic function and by clinical cardiac events is common in the first 3 months after OLT in patients with cirrhosis. HRV and BNP values in the T group were worse than in the C group, but this was not translated to an increase in cardiac clinical events in this study. (Liver

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Dispersion of the QT Interval and Autonomic Modulation of Heart Rate in Hypertensive Men With and Without Left Ventricular Hypertrophy

et al. 1996

Hypertension

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Left ventricular hypertrophy is an independent risk factor for sudden cardiac death in hypertension, but the mechanisms of electrical instability associated with hypertrophy are not well known. We studied dispersion of the QT interval, an index of inhomogeneity of repolarization, and heart rate variability, a measure of cardiac autonomic modulation, in a randomly selected population of 162 men with systemic hypertension and made comparisons between the patients with echocardiographic evidence of left ventricular hypertrophy (left ventricular mass index > or = 131 g/m2, n = 44) and those without hypertrophy (left ventricular mass index < 131 g/m2, n = 118). The heart rate-corrected QT dispersion (67 +/- 37 versus 53 +/- 21 milliseconds, P < .05) and QT apex dispersion (55 +/- 22 versus 44 +/- 16 milliseconds, P < .01) were significantly longer in the patients with left ventricular hypertrophy than in those without hypertrophy. Thirteen of the 44 patients (30%) with hypertrophy versus 7 of the 118 patients (6%) without hypertrophy had an abnormally long QT apex dispersion ( > 70 milliseconds) (P < .001). The time and frequency domain measures of heart rate variability did not differ significantly between the patient groups with and without left ventricular hypertrophy. The measures of heart rate variability were not related to QT dispersion or left ventricular mass index but had a negative correlation with blood pressure values (eg, r = -.30 between the low-frequency component of heart rate variability and systolic pressure, P < .001). Age, body mass index, antihypertensive medication, and the other demographic variables were similar between the groups, but the patients with left ventricular hypertrophy had higher systolic (P < .01) and diastolic (P < .01) pressures compared with the patients without hypertrophy. Left ventricular hypertrophy in hypertensive men is associated with inhomogeneity of the early phase of ventricular repolarization, favoring susceptibility to reentrant ventricular tachyarrhythmias. Abnormalities in cardiac autonomic function, which may trigger a spontaneous onset of arrhythmias, are related to elevated blood pressure but not specifically to left ventricular hypertrophy.

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Impaired heart rate variability and increased ventricular ectopic activity in patients with left ventricular hypertrophy

Cited by 3 publications

References 15 publications

Heart Rate Variability and Non-Linear Dynamics in Risk Stratification

Heart Rate Variability and Non-Linear Dynamics in Risk Stratification

Cardiac function after orthotopic liver transplantation and the effects of immunosuppression: A prospective randomized trial comparing cyclosporin (Neoral) and tacrolimus

Dispersion of the QT Interval and Autonomic Modulation of Heart Rate in Hypertensive Men With and Without Left Ventricular Hypertrophy

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