Clinical and Echocardiographic Predictors of Arrhythmias Detected With 24-Hour Holter Electrocardiography Among Hypertensive Heart Failure Patients in Nigeria

Abstract

Background: Hypertensive heart failure (HHF) is the commonest form of heart failure in Nigeria. There is paucity of data in Nigeria on 24-hour Holter electrocardiography (24-HHECG) and important predictors of arrhythmias among HHF patients. Objectives: To determine the 24-HHECG characteristics among HHF patients. To determine the clinical and echocardiographic predictors of arrhythmias detected using 24-HHECG among HHF patients. Methods: A total of 100 HHF patients as well as 50 age-matched and sex-matched apparently healthy controls were prospectively recruited over a period of 1 year. They all had baseline laboratory tests, echocardiography, and 24-HHECG. Results: Hypertensive heart failure patients had significantly higher counts of premature ventricular contractions (PVCs) than the controls ( P ≤ .001). Ventricular tachycardia (VT) was recorded in 29% of HHF patients as compared with controls who had no VT on 24-HHECG. The standard deviation of all normal to normal sinus RR intervals over 24 hours (SDNN) was abnormally reduced among HHF patients when compared with controls ( P = .046). There was positive correlation between atrial fibrillation (AF) and the following parameters: PVCs ( r = .229, P = .015), New York Heart Association (NYHA) ( r = .196, P = .033), and VT ( r = .223, P = .018). Following multiple linear regression, left ventricular ejection fraction (LVEF) ( P ≤ .001) and serum urea ( P = .037) were predictors of PVCs among HHF patients. Serum creatinine ( P ≤ .001), elevated systolic blood pressure (SBP) ( P = .005), and PVCs ( P ≤ .001) were important predictors of VT among HHF patients. Conclusions: Renal dysfunction and reduced LVEF were important predictors of ventricular arrhythmias. High counts of PVCs and elevated SBP were predictive of the occurrence of VT among HHF patients. The NYHA class and ventricular arrhythmias have a significant positive correlation with AF. The SDNN is reduced in HHF patients.