Late potentials in patients with different models of left ventricular hypertrophy and isolated diastolic dysfunction after aortic valve replacement

Abstract

Background: Left ventricular hypertrophy is an independent predictive factor of cardiovascular mortality. It is associated with complex ventricular arrhythmias. Patients with aortic valve stenosis have higher incidence of sudden cardiac death. The presence of late ventricular potentials (LVP) detected with signal averaged electrocardiography (SAECG) represents an arrhythmia substrate in the myocardium and is a strong predictor for malignant ventricular arrhythmias. Aim: The aim of the study was to identify factors determining the occurrence of LVP in patients after aortic valve replacement (AVR), paying particular attention to LVH pattern and LV diastolic function. Method and groups: We studied 39 patients after aortic valve replacement (27 women and 12 men; age 65.95 ±7.87 years) with normal ejection fraction and without ischemic heart disease. They were divided according to left ventricular mass index and relative wall thickness in three groups: eccentric LV hypertrophy (group 1), concentric remodeled ventricle (group 2), concentric hypertrophy (group 3).Additionally three other groups were formed according to the severity of the LV diastolic dysfunction: impaired relaxation (group A), pseudonormalization (group B) and restriction (group 3). M-mode, B-mode echocardiography, Doppler echocardiography, 24 h. Holter ECG and SAECG were performed. Late potentials were present when at least two criteria in SAECG were positive. Results: The incidence of LVP in group 1 was 33.3% and in group 3 - 30%. These were the groups with LVMI > 125 g/m2. In group 2 (LVMI < 125 g/m2), the incidence of LVP was 18.2%. We found significant differences in LAS 40 between group 1 and 2 (A° = 0.028), and between group 1 and 3 (A° = 0.026). We discovered significant negative correlations between LAS 40 and the diameter of the ascending aorta (r = -0.507, p=0.023), RMS 40 and IVRT (r =-0.470, p=0.012). There were no correlations between the components of the late ventricular potentials and preoperatively measured peak and mean transaortic pressure gradients. Conclusions: The incidence of late potentials is higher in patients with left ventricular hyper trophy and impaired LV relaxation. The concentric LVH probably carries higher SCD risk. The ventricular arrhythmias risk does not correlate with the stenos is grade but depends on the severity and the pattern of left ventricular hyper trophy.