Heart Institute, School of Medicine, University of São Paulo, Brazil

Correspondence to: Clovis de Carvalho Frimm, Heart Institute, School of Medicine, University of São Paulo, Av. Dr.Eneas de Carvalho Aguiar, 44 05403-900 - São Paulo, SP, Brazil

Left ventricular hypertrophy is associated with an increased cardiovascular mortality in hypertension. A potential role of ventricular arrhythmias is debated but not yet determined. The purpose of this study was to evaluate whether the presence of arrhythmias would ascribe any additional risk to cardiovascular mortality beyond that related to the presence of left ventricular hypertrophy. From November 1988 to February 1991, 40 mild to severe hypertensive patients (mean SBP, DBP 183/117 mm Hg) were submitted to clinical, echocardiographic and electrocardiographic evaluations complemented by 24-h Holter monitoring and then followed until November 1996. The Kaplan-Meier method supplemented by the Cox multiple regression model were performed to identify the variable(s) associated with fatal cardiovascular outcome. Twelve cardiovascular fatalities occurred as a consequence of sudden death (n = 4), stroke (n = 4), heart failure (n = 2) and myocardial infarction (n = 2). In comparison with patients who survived, those dying from cardiovascular causes had a greater percentage of electrocardiographic left ventricular hypertrophy (83 vs 36%, P = 0.0037) and couplets of ventricular ectopic beats (58 vs 18%, P = 0.0467). In addition, they showed larger left ventricular diastolic diameter (60 ± 10 vs 53 ± 8 mm), mass index (248 ± 67 vs 154 ± 57 g/m²) and posterior wall thickness (12 ± 2 vs 10 ± 2 mm), as well as shorter left ventricular fractional shortening (0.23 ± 0.8 vs0.32 ± 0.9). Univariate analysis showed that electrocardiographic left ventricular hypertrophy and strain, mass index, end-systolic wall stress, fractional shortening and the presence of couplets were significantly related to cardiovascular mortality. However, only mass index was shown to be independently associated with cardiovascular death. In conclusion, left ventricular hypertrophy predicts cardiovascular outcome, regardless of the presence of other signs of cardiac damage, including ventricular arrhythmia.

hypertrophy; arrhythmias; cardiovascular mortality; echocardiography; Holter