Abstract 326: Valvular Regurgitations May Increase Arrhythmias in Hypertensive Heart Failure in Blacks

Abstract

Hypertensive heart disease(HHD) in Nigerians, is associated with concentric LVH and a high frequency of early valvular regurgitations (VR). HHD is the commonest cause of sudden cardiac death (SCD) in that population, but the role of arrhythmias in these is not known. We therefore (a)investigated the relationship between VR and cardiac arrhythmias in normotensives, hypertensives, and hypertensive heart failure (HHF) in Nigerians and (b) examined the hypothesis that VR increases the prevalence and complexity of cardiac arrhythmias in HHF Nigerians. HHF patients (n=14), HHD patients (n= 23) and Normal controls (N) n=9 underwent 24 hr Holter EKG monitoring and 2D and Doppler Echocardiography, and the presence or absence of VR noted in each individual and groups. Each patient group was sub classified into those with VR or without VR (NVR). There were significant between patient group differences in SVT P<0.001ANOVA),mean and median VT frequency (p <0.02) and ventricular couplets (p= 0.0002 ANOVA). HHF with VR had more SVT (81/24HRS) than HHF with NVR (4/24HRS) p = 0.016, as well as more VT/Triplets(69/24HRS) than HHF-NVR (34/24HRS) p <0.02 . HHF with VR had more couplets 446/24HRS than HHF-NVR (58/24HRS) p _ 3 VALVES) had the greatest number of dangerous arrhythmias with VT 6/11 or 55%, but only 3/19 ( 19%) in NVR .

The number of regurgitant valves was positively correlated both to the frequency and the Lown class of arrhythmias (0-IVB)( r = 0.42 p=0.003, n=46), and to VT frequency/episodes ( r = 0.30, p=0.04 ANOVA , n=46). HHF with VR had lower EF but higher LVH compared to HHF NVR (p <0.05). These results support the role of valvular regurgitation in cardiac arrhythmogenesis and complex ventricular ectopy perhaps through connexin43 modification and LVH in HHD, and HHF.