Electrical properties of the myocardium in patients with arterial hypertension combined with subclinical hypothyroidism

Authors

  • V. V. Syvolap Zaporizhzhia State Medical University, Ukraine,
  • Ye. V. Novikov Zaporizhzhia State Medical University, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2019.5.179405

Keywords:

hypothyroidism, arterial hypertension, 24-h ECG monitoring, heart atria, heart ventricles

Abstract

 

Late atrial and ventricular potentials are non-invasive electrocardiographic criteria for presence of high arrhythmic readiness and risk of life-threatening arrhythmias. The electrical properties of the myocardium in patients with stage II arterial hypertension (AH) combined with subclinical hypothyroidism have not been studied previously.

Aim. To study the changes of electrical properties of the atrial and ventricular myocardium in patients with AH combined with subclinical hypothyroidism.

Materials and methods. The criteria for inclusion in the study were the presence of stage II AH without thyroid gland pathology and combined with subclinical hypothyroidism (SH) (for patients of the main group). Depending on the level of thyroid-stimulating hormone (TSH), the AH patients were divided into 2 groups – with normal (0.4–4.0 mU/ml) and moderately elevated level of TSH (4.0–15.6 mU/l, with normal levels of thyroid hormones).

The group of patients with AH without SH included 92 patients (women – 81.52 % (75), men – 18.48 % (17)); the group of patients with AH with concomitant SH included 30 patients (women – 86.7% (26), men – 13.3 % (4)). All patients underwent 24-h BP monitoring and ECG (combined ECG and BP monitor “Kardiotechnica-04-AD-3”,St. Petersburg,Russia). A 40 Hz cutoff filter was used recording in the X, Y, Z orthogonal leads. Data were processed with the help of a program Statistica 6.0. Data were presented as the median and inter-quartile range of Me (25 %; 75 %).

Results. In AH patients without concomitant subclinical hypothyroidism, unlike in relatively healthy patients, late atrial potential predominance was seen (63 % vs. 84 %; P = 0.0419) with a 16.4 times (P = 0.018) increase in the number of premature atrial contractions. Also, in patients with AH without concomitant subclinical hypothyroidism late ventricular potentials (LVPs) occurred 5.7 times more often (6 % vs. 34 %, P = 0.0302) and were associated with a significant (P = 0.004) increase in the number of premature ventricular contractions per day in this category of patients.

In SH patients with a concomitant subclinical hypothyroidism, unlike in relatively healthy individuals, atrial ectopic activity was significantly more predominant (LAP was found in 87 %; versus 63 %, P = 0.0498), which was accompanied by a logical 27.2 times (P = 0.038) increase in the number of premature atrial contractions and ventricular ectopic activity. Changes in the electrical properties of the ventricles were accompanied by an increase in the percentage of detected LVPs (77 % versus 6 %, P = 0.0001), which was associated with a significant (P = 0.001) increase in the number of premature ventricular contractions per day in this category of patients (441.53 ± 1414.97 versus 0.00 ±0.00 inalmost healthy subjects, P = 0.001).

AH patients with and without concomitant SH did not differ from each other in terms of indexes characterizing late atrial potentials. There was also no statistically significant difference in the number of premature atrial contractions (P = 0.527), paired premature atrial contractions (P = 0.449), salvos of atrial premature contractions (P = 0.314). However, in AH patients with concomitant SH there was a significant increase in the ectopic activity of the ventricles – LVPs were found in 77 % vs. 33 % in individuals without SH (P = 0.0001), changes in the electrical properties of ventricles in AH patients with concomitant SH were also associated with an increase in the number of premature ventricular contractions by 6.69 times (from 42.56 ± 36.96 to 441.53 ± 1414.97, P = 0.026) compared with the same index in patients with AH without concomitant SH, indicating the negative effect of SH on the electrical properties of the ventricles.

Conclusions. In patients with stage II arterial hypertension in comparison to relatively healthy subjects, indicators that characterize the late potentials of the atria and ventricles are significantly changed, which is accompanied by an increase in the number of supraventricular and ventricular rhythm disorders. Subclinical hypothyroidism causes an additional pro-arrhythmic effect on the ventricular myocardium in arterial hypertension.

 

References

Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., & Bohm, M. (2013). ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J., 34(28), 2159–2190.

Montezano, A. C., Dulak-Lis, M., Tsiropoulou, S., Harvey, A., Briones, A. M., & Touyz, R. M. (2015). Oxidative stress and human hypertension:vascular mechanisms, biomarkers, and novel therapies. Can JCardiol. 31(5), 631–641. doi: 10.1016/j.cjca.2015.02.008

Radulescu, D., Stoicescu, L., Buzdugan, E., & Donca, V. (2013) Patterns of leftventricular remodeling among patients with essential andsecondary hypertension. Revista medica de Chile.141(12), 1520–1527. doi: 10.4067/S0034-98872013001200004

Sultana, R., Sultana, N., Rashid, A., Rasheed, S. Z., Ahmed, M., Ishaq, M., & Samad, A. (2010) Cardiac arrhythmias and left ventricular hypertrophy insystemic hypertension. J Ayub Med Coll Abbottabad, 22(4), 155–158.

Shenasa, M., Shenasa, H., & El-Sherif, N. (2015) Left VentricularHypertrophy and Arrhythmogenesis. Card electrophysiol clini, 7(2), 207–209. doi: 10.1016/j.ccep.2015.03.017

Kahan, T., & Bergfeldt, L. (2005). Left ventricular hypertrophy inhypertension: its arrhythmogenic potential. Heart, 91(2), 250–256. doi: 10.1136/hrt.2004.042473

Yiu, K., & Tse, H. (2008). Hypertension and cardiac arrhythmias: a review of the epidemiology, pathophysiology and clinical implications. J Hum Hypertens, 22(6), 380–388. doi: 10.1038/jhh.2008.10

Santangeli, P., Infusino, F., Sgueglia, G. A., Sestito, A., & Lanza, G. A. (2008) Ventricular late potentials: a critical overview and current applications. J Electrocardiol, 41(4), 318–324. doi: 10.1016/j.jelectrocard.2008.03.001

The AFFIRM Investigators. (2002). Baseline characteristics of patients with atrial fibrillation: the AFFIRM study. Am Heart J. 143(6), 991–1001. doi: 10.1067/mhj.2002.122875

Madu, E. C., Baugh, D. S., Gbadebo, T. D., Dhala, A., & Cardoso, S. (2001). Effect of ethnicityand hypertension on atrial conduction: evaluation with high-resolution Pwavesignal averaging. Clin Cardiol., 24(9), 597–602. doi: 10.1002/clc.4960240906

Kannel, W. B., Wolf, P. A., Benjamin, E. J., & Levy, D. (1998). Prevalence, incidence, prognosis,and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol., 82(suppl), 2N–9N. doi: 10.1016/s0002-9149(98)00583-9

Verdecchia, P., Reboldi, G., Gattobigio, R., Bentivoglio, M., Borgioni, C., Angeli, F., et al. (2003). Atrial fibrillation in hypertension: predictors and outcome.Hypertension. 41(2), 218–223. doi: 10.1161/01.hyp.0000052830.02773.e4

Bagueta, J., Erdineb, S., & Malliona, J. (2005). Hypertension and arrhythmia. Eyropean Society of Hypertension Scientific Newsletter: Update on Hypertension Management, 24, 1–2.

Mozos. I., et al. (2012). Late ventricular potentials in cardiac and extracardiac diseases, in Cardiac arrhythmias. Breijo-Marquez FR. Intech, Rijeka, Croatia. 227–256.

Benchimol Barbosa, P. R., de Souza Bomfim, A., Barbosa, E. C., Ginefra, P., Helena Cardoso Boghossian, S., Destro, C., & Nadal, J. (2005). Spectral turbulence analysis ofthe signal-averaged electrocardiogram of the atrial activation as predictor of recurrenceof idiopathic and persistent atrial fibrillation. International Journal of Cardiology., 107(3), 307–316. doi: 10.1016/j.ijcard.2005.03.073

Galinier, M., Balanescu, S., Fourcade, J., Dorobantu, M., Albenque, J. P., Massabuau, P., et al. (1997). Prognostic value of arrhythmogenic markers in systemic hypertension. Eur Heart J., 18(9), 1484–1491. doi: 10.1093/oxfordjournals.eurheartj.a015476

Benchimol-Barbosa, P. R., Barbosa, E. C., Bomfim, A. S., Ginefra, P., & Nadal, J. (2002) Clinical assessment of the effect of digitalfiltering on the detection of ventricular late potentials. Brazilian Journal of Medical andBiological Research., 35(11), 1285–1292. doi: 10.1590/S0100-879X2002001100005

Ramos, J. A., & Lopes dos Santos, P. J. (2012). Parametric modeling in estimating abnormal intra-QRSpotentials in signal-averaged electrocardiograms: A subspace identification approach Interpreting Cardiac Electrograms – From Skin to EndocardiumIn: 16th IFAC Symposium on System Identification, the International Federation ofutomatic Control. Brussels, Belgium, published by Elsevier Ltd.

Abdelghani, S. A., Rosenthal, T. M., & Morin, D. P. (2016). Surface electrocardiogram predictors of suddencardiac arrest. Ochsner Journal., 16(3), 280–289

Gadaleta, M., & Giorgio, A. (2012). A method for ventricular late potentialsdetection using time-frequency representation and waveletdenoising. ISRN cardiology, 2012, 258769. doi: 10.5402/2012/258769

Barison, A., Vergaro, G., Pastormerlo, L. E., Ghiadoni, L., Emdin, M., & Passino, C. (2011). Markers of arrhythmogenic risk in hypertensive subjects. Curr Pharm Des, 17(28), 3062–3073. doi: 10.2174/138161211798157748

Bushra, R., Syed, M., Khan, M., et al. (2016). Association of ventricular late potentials with left ventricular hypertrophy in patients with systemic arterial hypertension. Pak Armed Forces Med J., 66, 841–844.

Palmiero, P. &, Maiello, M. (2004). Arrhythmic risk in essential hypertension: latepotentials. Minerva Cardioangiol., 52(1), 1–8.

Riaz, B., Khan, M., Mubarak, S., & Sarwar, M. (2015). Correlation of signal averaged ECG parameters with arterial blood pressure in hypertensive patients. Pak J Physiol., 11(4), 6–9.

Zipes, D., Camm, J., Borggrefe, M., Buxton, A. E., Chaitman, B., Fromer, M., et al. (2006) ACC/AHA/ESC guidelines for managementof patients with ventricular arrhythmias and the prevention of sudden cardiac death: Areport of the AmericanCollege of Cardiology/American Heart Association Task Forceand the European Society of Cardiology Committee for Practice Guidelines (WritingCommittee to develop guidelines for management of patients with ventricular arrhythmiasand the prevention of sudden cardiac death). Journal of the American College ofCardiology, 48(5), 247–346. doi: 10.1016/j.jacc.2006.07.010

Maffei, P., Martini, C., Milanesi, A., Corfini, A., Mioni, R., de Carlo, E., et al. (2005). Late potentials and ventricular arrhythmias inacromegaly. International Journal of Cardiology, 104(2), 197–203. doi: 10.1016/j.ijcard.2004.12.010

Mosca, S., Paolillo, S., Colao, A., Bossone, E., Cittadini, A., Iudice, F. L., et al. (2013). Cardiovascular involvement in patients affected byacromegaly: An appraisal. International Journal of Cardiology, 167(5), 1712–1718. doi: 10.1016/j.ijcard.2012.11.109

Ker, J. (2015). Thyroxine and cardiac electrophysiology – a forgotten physiological duo? Thyroid Research., 5(1), 8. doi: 10.1186/1756-6614-5-8

Schippinger, W., Buchinger, W., Schubert, B., et al. (1995). Late potentials in high resolution ECG inthyroid gland dysfunction. Acta Medica Austriaca., 22(4), 73–74.

Yao, Z., Gao, X., Liu, M., Chen, Z., Yang, N., Jia, Y. M., et al. (2018). Diffuse Myocardial Injuries are Present in Subclinical Hypothyroidism: A Clinical Study Using Myocardial T1-mapping Quantification. Scientific Reports., 8(1), 4999. doi: 10.1038/s41598-018-22970-x

Buzea, C. A., Dan, A. R., Delcea, C., Balea, M. I., Gologanu, D., Dobranici, M., et al. (2015). P wave signal-averaged electrocardiography in patientswith chronic obstructive pulmonary disease. Romanian Journal of Internal Medicine, 53(4), 315–320. doi: 10.1515/rjim-2015-0040

Yogodawa, K., Seino, Y., Ohara, T., Hayashi, M., Miyauchi, Y., Katoh, T., & Mizuno, K. (2013). Prediction of atrial fibrillation after ischemic strokeusing P-wave signal averaged electrocardiography. Journal of Cardiology, 61(1), 49–52. doi: 10.1016/j.jjcc.2012.08.013

Galimzyanov, E'. R. (2011). Optimizaciya metoda obrabotki e'lektrokardiosignalov dlya vyyavleniya nizkoamplitudnykh potencialov serdca [Optimization of the processing method of electrocardiosignals to identify low-amplitude potentials of the heart]. Metody i ustrojstva peredachi i obrabotki informacii, 13, 26–29. [in Russian].

Matsuzaki, A., Yoshioka, K., Amino, M., Shima, M., Hashida, T., Fujibayashi, D., et al. (2014). Usefulness of Continuous 24-hour Ventricular Late Potential to Predict Prognosis in Patients with Heart Failure. Tokai J Exp Clin Med., 39(3), 128–136.

Sedov, S. S., Shcherbakova, T. F., & Galimzyanov, E. R. (2018). Analiz pozdnikh potencialov zheludochkov serdca s ispolzovaniem portativnykh kardioanalizatorov [Analysis of late potentials of heart ventricles with use of portable cardio analyzers]. Mezhdunarodnyj nauchno-issledovatelskij zhurnal, 12-5(66), 127–129. [in Russian].

How to Cite

1.
Syvolap VV, Novikov YV. Electrical properties of the myocardium in patients with arterial hypertension combined with subclinical hypothyroidism. Zaporozhye Medical Journal [Internet]. 2019Oct.1 [cited 2024Jun.18];(5). Available from: http://zmj.zsmu.edu.ua/article/view/179405

Issue

Section

Original research