Cardiac memory versus likelihood of ischemic heart disease in hypertensive patients with ventricular repolarization abnormalities after repetitive uniform ventricular extrasystoles.

OBJECTIVES

To investigate the value of T-wave inversion after premature ventricular complexes (PVCs) for the prediction of hypertensive patients with a likelihood of ischemic heart disease (IHD).

PATIENTS AND METHODS

Ambulatory 24-hour ECG, ambulatory 24-hour blood pressure (BP) recording, echocardiography, treadmill exercise ECG test and thallium-201 scintigraphy were performed for 210 hypertensive patients.

RESULTS

Predictive indices showed that persistent symmetrical T-wave inversion after repetitive uniform PVCs equaling 30 min can be considered an indicator for the prediction of IHD in hypertensive patients as sensitivity was 80%, specificity: 73%, accuracy: 78%, positive predictive value: 83%, and negative predictive value: 69%. kappa coefficient value (kappa) indicated that there was good agreement between changes in ventricular repolarization after PVCs and stress thallium scintigraphy (kappa = 0.897). Receiver-operating characteristic curve data showed that the ideal cutoff value of T-wave inversion voltage to predict IHD in hypertensive patients was 2.2 mV (sensitivity: 66% and false positive: 35%, and area under curve: 0.716), but the ideal cutoff value of time for resolution of T-wave inversion was 34 min (sensitivity: 83% and false positive: 18%, and area under curve: 0.873). Multivariate analysis revealed that T-wave inversion after repetitive uniform PVCs was significantly associated with non-sustained ventricular tachycardia, decreased parasympathetic activity, increased sympathetic activity, morning BP surge, systolic BP load >50% and left ventricular diastolic dysfunction status.

CONCLUSION

The data show that persistent symmetrical T-wave changes following resumption of sinus rhythm after repetitive uniform PVCs are an independent variable for the prediction of IHD in hypertensive patients.