The pattern of 24-hour Holter ECG monitoring parameters and features of structural and functional state of the myocardium depending on aldosterone level in patients with arterial hypertension and frequent recurrences of atrial fibrillation
DOI:
https://doi.org/10.14739/2310-1210.2018.5.141634Keywords:
hypertension, atrial fibrillation, heart rate, circadian rhythm, electrocardiography, echocardiography, ventricular remodelingAbstract
In recent times great attention of researchers has been focused on the heart electrical and structural remodeling features study in patients with atrial fibrillation (AF). First of all, the electrocardiography Holter monitoring (ECG HM) and echocardiography are used as methods for these changes assessment.
Aim of the work – to estimate the features of heart rhythm disorders according to the ECG HM data and intracardiac hemodynamics features registered by echocardiography in patients with arterial hypertension (AH) and frequent recurrences of AF.
Materials and methods. 146 patients with AH stage II were examined. 26 patients with AH stage II without AF were examined as a comparison group. Paroxysmal form of AF was in 56 (38.4 %) patients and persistent form of AF was in 90 (61.6 %) patients. The vagally induced variant of AF was determined in 31 (21.2 %) patients, the adrenal variant of AF in 70 (47.9 %) and mixed variant of AF in 45 (30.9 %). All patients underwent ECG HM and transthoracic echocardiography according to the standard protocol. The level of aldosterone in serum was determined by ELISA. The relatively low level of aldosterone (RLLA) was defined as <62 pg/ml and relatively high level of aldosterone (RHLA) as >184 pg/ml, intermediate level of aldosterone (ILA) was 62–184 pg/ml. Based on the aldosterone levels, 3 groups of patients were identified: 1 – patients with RLLA (n = 37), 2 – with ILA (n = 72) and 3 – with RHLA (n = 37). Statistical analysis of the study was carried out using standard methods with the software package StatSoft Statistica v. 12.0.
Results. The 24-hour heart rate (Р = 0.04) and circadian index (CI) (P = 0.03) were increased in the RHLA group in comparison with the RLLA group. The CI value was significantly higher in the ILA group in comparison with the RLLA group (P = 0.02). The part of supraventricular paroxysmal tachycardia (SVPT) episodes was significantly higher in the RHLA group in comparison with the ILA and RLLA groups (P = 0.05 and P = 0.04, respectively). The number of AF episodes registered throughout a 24-hour period was higher in patients with RHLA and ILA in comparison to the RLLA group of (P = 0.02 and P = 0.03, respectively). The total duration of these episodes throughout a 24-hour period was significantly higher in the RHLA group in comparison with the ILA and RLLA groups (P = 0.001 and P = 0.007, respectively). The number of patients with ventricular premature contractions (VPC) was significantly higher in the group with RHLA in comparison with the RLLA group (P = 0.009). The percentage of couplets and salvos VPC in the RHLA group was higher in comparison with the other patient groups (P = 0.05 and P = 0.04, respectively).
The moderate mitral regurgitation was observed more frequently in the group with RHLA in comparison with the RLLA group (P = 0.02). The tricuspid regurgitation was observed more frequently in patients with RHLA in comparison with the ILA and RLLA groups (P = 0.01 and P = 0.02, respectively). The frequency of moderate tricuspid regurgitation was significantly higher in the RHLA group in comparison with the other patient groups the (P = 0.05 and P = 0.004, respectively).
Conclusions. In patients with AH stage II and frequent recurrences of AF the RHLA (>184 pg/ml) is associated with the signs of atriums and ventricles increased electrical instability, characterized by higher 24-hour heart rate and CI; increased frequency of SVPT and AF episodes registration, number and total duration of AF episodes throughout a 24-hour period; increased frequency of VPC registration, including couplets and salvos VPC. In patients with AH stage II and frequent recurrences of AF the RHLA is associated with increased frequency of moderate mitral and tricuspid regurgitation registration.
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