CLINICAL ASSESSMENT OF LIFE-THREATENING VENTRICULAR ARRHYTHMIA PREDICTORS IN PATIENTS WITH VENTRICULAR EXTRASYSTOLIA AND NO MORPHOLOGICAL HEART PATHOLOGY (A PROSPECTIVE STUDY)

Abstract

The study aim was a prospective clinical assessment of life-threatening ventricular arrhythmia (LTVA) predictors in patients with ventricular extrasystolia (VE) and no morphological heart pathology. From 1997 to 2002, 199 patients, aged 18-35 years (mean age 27,3±2,6 years), with neuro-circulatory dystonia (NCD) and Lown Class II-V VE, were followed up. All participants underwent general clinical examination and the assessment of late ventricular potentials (LVP), QT interval dispersion (QTd), VE heart rate turbulence (HRT), and potential pathogenetic VE mechanisms. In NCD patients with VE due to early post-depolarization and re-entry mechanisms, VE was a predictor of coronary heart disease (CHD) and arterial hypertension (AH), with positive predictive values (PPV), respectively, of 74% and 44%. If these patients received Class III medications for VE treatment, and/or unstable ventricular tachycardia was developed, the risk of CHD increased up to 93%. In NCD patients with VE due to delayed post-depolarisation mechanism, PPV for gastrointestinal disease (GID) was 61%. For LVP, QTd>80 ms, and pathological VE HRT values, PPV in regard to future CHD, AH, or GID was under 30%. The predictors reflecting the mechanisms of VE development and LTVA risk were highly correlated (r>0,50) with traditional cardiovascular and gastrointestinal risk factors.

Keywords

• ventricular arrhythmias in patients without morphological heart pathology – predicting cardiovascular disease