Key result
Significant premature ventricular complexes on Holter ECG predicted 6-month mortality, while the walking distance test was not a significant predictor in hypertensive heart failure.
Why the study?
Do 24-hour Holter ECG and 6-minute walk test predict adverse outcomes in patients with hypertensive heart failure?
Cohort (n=100)
Do 24-hour Holter ECG and 6-minute walk test predict adverse outcomes in patients with hypertensive heart failure?
Holter ECG-detected arrhythmias, elevated serum urea, and high NYHA class are useful prognostic indicators for adverse outcomes in hypertensive heart failure, while the 6-minute walk test may not be.
Answers are grounded in this paper and cite their sources.
PVCs on Holter were associated with 6-month mortality in hypertensive HF; leaves open the added prognostic value of 6MWT.
Background: Hypertensive heart failure (HHF) is associated with a poor prognosis. There is paucity of data in Nigeria on prognosis among HHF patients elucidating the role of 24-hour Holter electrocardiogram (ECG) in concert with other risk factors. Objective: The aim of this study was to determine the prognostic utility of 24-hour Holter ECG, the 6-minute walk test (6-MWT), echocardiography, clinical and laboratory parameters among HHF patients. Methods: A total of 113 HHF patients were recruited and followed up for 6 months. Thirteen of these patients were lost to follow-up, and as a result only 100 HHF patients were analyzed. All the patients underwent baseline laboratory tests, echocardiography, 24-hour Holter ECG and the 6-MWT. HHF patients were analyzed as “mortality vs alive” and as “events vs no-events” based on the outcome at the end of 6 months. Events was defined as HHF patients who were rehospitalized for heart failure (HF), had prolonged hospital stay or died. No-events group was defined as HHF patients who did not meet the criteria for the events group. Results: HHF patients in the mortality group (n = 7) had significantly higher serum urea (5.71 ± 2.07 mmol/L vs 3.93 ± 1.45 mmol/L, p = 0.003) than that in those alive. After logistic regression, high serum urea conferred increased mortality risk ( p = 0.035). Significant premature ventricular complexes (PVCs) on 24-hour Holter ECG following logistic regression were also significantly higher ( p = 0.015) in the mortality group than in the “alive” group (n = 93) at the end of the 6-month follow-up period. The 6-minute walk distance (6-MWD) was least among the HHF patients who died (167.26 m ± 85.24 m). However, following logistic regression, the 6-MWT was not significant ( p = 0.777) for predicting adverse outcomes among HHF patients. Patients in the events group (n = 41) had significantly higher New York Heart Association (NYHA) class ( p = 0.001), Holter-detected ventricular tachycardia (VT; p = 0.009), Holter-detected atrial fibrillation (AF; p = 0.028) and PVCs ( p = 0.017) following logistic regression than those in the no-events group (n = 59). Conclusion: High NYHA class, elevated serum urea, Holter ECG-detected AF and ventricular arrhythmias are predictive of a poor outcome among HHF patients. The 6-MWT was not a useful prognostic index in this study.
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Mene‐Afejuku et al. (2017) conducted a cohort in Hypertensive heart failure (n=100). Clinical, laboratory, and 24-hour Holter ECG parameters vs. Patients without these risk factors was evaluated on Mortality and events (rehospitalization for heart failure, prolonged hospital stay or death) (p=0.015). Significant premature ventricular complexes on Holter ECG predicted 6-month mortality, while the walking distance test was not a significant predictor in hypertensive heart failure.
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