Assessment of Late Potentials in Patients with Essential Hypertension by the Signal-averaged Electrocardiogram with Five Year Follow-up

Both the Framingham and Manitoba Heart Studies have identified electrocardiographic left ventricular (LV) hypertrophy (LVH) as a risk factor for sudden cardiac death. Low amplitude ventricular late potentials in the terminal part of ventricular activation have been associated with sustained ventricular tachycardia and have identified those at risk for sudden cardiac death. Therefore, we prospectively examined 23 essential hypertensives without known symptomatic coronary heart disease by two-dimensional echocardiography and signal averaged electrocardiograms (SAECGs) for the detection of ventricular late potentials. The SAECG vector-magnitude complex measurements included the total duration of the complex (QRSd), the voltage in the last 40 ms (V40), and the duration of low amplitude signals < 40 microV in the terminal portion of the complex (LASd). Echocardiographic parameter means were: LV diastolic diameter = 46.0 +/- 4.5 mm, combined septal and posterior wall thickness = 23.3 +/- 4.2 mm, LV mass (Woythaler method) = 235.1 +/- 69.1 g, LV mass (Penn method) = 199.5 +/- 55.3 g and ejection fraction = 63.9 +/- 6.2%. SAECG measurement means were QRSd = 88.2 +/- 9.9 ms, V40 = 63.1 +/- 34.7 microV RMS, and LASd = 23.5 +/- 10.0 ms. No echocardiographic parameter correlated with SAECG duration; however, age correlated with QRSd (r = 0.48, P = 0.02). Posterior wall thickness (r = -0.43, P = 0.04), LV mass index (r = -0.44, P = 0.03) and LV mass/height (r = -0.49, P = 0.02) inversely correlated with LASd.(ABSTRACT TRUNCATED AT 250 WORDS)