MARKERS OF INCREASED RISK OF SUDDEN CARDIAC DEATH IN PATIENTS WITH STABLE ANGINA AND ARTERIAL HYPERTENSION: ASSOCIATION WITH THE PROGRESSION OF LEFT VENTRICULAR HYPERTROPHY

Abstract

Aim. To analyse the markers of sudden cardiac death (SCD) in patients with stable angina and arterial hypertension (AH), in regard to the progression of left ventricular hypertrophy (LVH). Material and methods. In total, 90 patients with Functional Class II–III stable angina, AH, and LVH were examined. The following parameters were assessed: left ventricular myocardial mass index (LVMMI), left ventricular ejection fraction (LVEF), heart rate variability (HRV) parameters (SDNN, HRVi, CBBP); mean 24-hour HR levels, QT and QTc intervals, QT dispersion (QTds), ectopic ventricular activity; mean 24-hour blood pressure (BP) levels; levels of serum markers of myocardial collagenolysis and N-terminal pro-brain natriuretic peptide (NT-proBNP). Results. In all participants, LVEF was preserved, without significant difference between the tertiles. The increase in LVMMI was linked to a significant increase in the total number of ventricular extrasystoles (VE) over 24 hours (p<0,001) and the mean number of paired (p><0,008) and polytopic (p>< 0,011) VE per patient; reduced HRV, based on the SDNN dynamics (p=0,004); increased mean 24-hour pulse BP (p=0,003); elevated levels of tissue inhibitors of matrix metalloproteinase-1 (p=0,017) and NT-proBNP; and decreased levels of procollagen type I C-terminal telopeptide (p=0,011). Conclusion. In patients with stable angina, AH, and preserved LVEF, the LVH progression is associated with an increased number of SCD markers: increased ventricular ectopic activity, reduced HRV, increased mean 24-hour BP, and elevated levels of NT-proBNP and serum markers of myocardial fibrosis, which confirms the increase in the risk of SCD in parallel to the increase in the LVMMI.

Keywords

• stable angina
• arterial hypertension
• left ventricular hypertrophy
• sudden death markers