Impact of left ventricular hypertrophy on frequency and complexity of ventricular arrhythmia among hypertensive Egyptian patients

Ahmed Mokhtar Abd El Azeem; Mohamed Ahmed Abd Elmoneim; Samir Morkos Rafla; Gehan Magdy Youssif

doi:10.1186/s43044-024-00472-8

Impact of left ventricular hypertrophy on frequency and complexity of ventricular arrhythmia among hypertensive Egyptian patients

Egypt Heart J. 2024 Mar 26;76(1):37. doi: 10.1186/s43044-024-00472-8.

Authors

Ahmed Mokhtar Abd El Azeem¹, Mohamed Ahmed Abd Elmoneim², Samir Morkos Rafla³, Gehan Magdy Youssif³

Affiliations

¹ Cardiology Department, Faculty of Medicine, Alexandria University, Champlion Street, El Azarita, Alexandria, Egypt. dramokhtar84@yahoo.com.
² Kafr El-Dawar General Hospital, Ministry of Health, Kafr El Dawwar, Egypt.
³ Cardiology Department, Faculty of Medicine, Alexandria University, Champlion Street, El Azarita, Alexandria, Egypt.

Abstract

Background: Left ventricular hypertrophy (LVH) is associated with an increased risk of ventricular arrhythmias and cardiovascular mortality. The study objective was to investigate the effect of LVH severity on the complexity and severity of ventricular arrhythmias among a subset of Egyptian hypertensive patients.

Results: The study cohort consisted of 60 hypertensive patients with LVH as diagnosed by echocardiography. Their mean age was (53.7 ± 12.3) years. 36 males (40%) and 24 females (60%). Diabetes mellitus was found in 26 patients (43%), 41% of these cases were smokers. 48-h Holter monitoring was performed in all cases to assess the frequency of ventricular premature contractions (VPC) and their complexity using the Lown grading. Increasing posterior wall thickness end diastole (PWTd) was an independent predictor of increasing VPC frequency, each 1 mm increase in the PWTd is associated with a 1.26% increase in the VPC% among total heart beats (b = 12.6, p < 0.001). Higher-grade VPCs-defined as grade 4a, 4b, and 5-were seen in 29 patients (48.3%). Interventricular septum thickness end diastole, PWTd, left ventricular mass, and left ventricular mass index (LVMI), were significantly higher among patients with higher Lown grading (p < 0.001). Using logistic regression analysis, female sex and LVMI were independent predictors of more complex VPC (OR = 8.766, p = .014), (OR = 1.096, p < 0.001), respectively. Among females, LVMI of more than 120 g/m² can differentiate between high- and low-grade VPCs with 71% sensitivity and 80% specificity, while among males, LVMI of more than 129.5 g/m² can differentiate between high and low-grade VPCs with 86% sensitivity and 66% specificity.

Conclusions: The frequency and complexity of ventricular arrhythmias among hypertensive heart disease are correlated with the severity of ventricular hypertrophy. Female sex and increasing left ventricular mass index are independent predictors of more complex forms of ventricular arrhythmias.

Keywords: Left ventricular hypertrophy; Left ventricular mass index; Lown grading; Ventricular arrhythmia; Ventricular premature contraction.