Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy.

Abstract

Objective-To assess the prevalence of symptomatic and silent myocardial ischaemia in patients with hypertensive left ventricular hypertrophy.Design-Cross sectional study. Setting-University department of medical cardiology.Patients-90 patients (68 men and 22 women; mean age 57 (range 25 to 79)) with left ventricular hypertrophy due to essential hypertension.Interventions-48 hour ambulatory ST segment monitoring (all patients), exercise electrocardiography (n = 79), stress thallium scintigraphy (n = 80), coronary arteriography (n = 35).Results-43 patients had at least one episode of ST segment depression on ambulatory electrocardiographic monitoring. The median number of episodes was 16 (range 1 to 84) with a median duration of 8-6 (range 2 to 17) min. Over 90% of these episodes were clinically silent. 26 patients had positive exercise electrocardiography and 48 patients had reversible thallium perfusion defects despite chest pain during exercise in only five patients. 18 of the 35 patients who had coronary arteriography had important coronary artery disease. Seven of these patients gave no history of chest pain.Conclusions-Symptomatic and silent myocardial ischaemia are common in hypertensive patients with left ventricular hypertrophy, even in the absence of epicardial coronary artery disease. Despite the large number of epidemiological studies there are few data on the objective assessment of myocardial ischaemia in individual patients with hypertensive left ventricular hypertrophy. We have shown previously that patients with hypertensive left ventricular hypertrophy may have thallium perfusion abnormalities or coronary artery disease and yet be symptom free.6 Because chest pain was an exclusion criterion for the previous study, however, the patients were not representative of all patients with hypertensive left ventricular hypertrophy. We therefore conducted the present study to assess prevalence of symptomatic and asymptomatic myocardial ischaemia in hypertensive patients with left ventricular hypertrophy attending a hospital based hypertension clinic and to determine the best non-invasive method to identify prognostically important coronary artery disease in these patients. Patients and methodsWe recruited 90 consecutive patients (68 men) (mean age 57 (range 25 to 79) years) who agreed to be in the study and fulfilled the following criteria:(a) they had essential hypertension-secondary hypertension was excluded by clinical evaluation, routine biochemical screening, chest x ray, and, where indicated, intravenous pyelography. (b) they had the electrocardiographic pattern of left ventricular hypertrophy and strain.

High Prevalence of Myocardial Ischemia and Vasoconstrictive Hormonal Release in Hypertension during Chronic Renal Failure

“…In fact, perfusion imaging is more reliable than radionuclide angiography in identifying coexistent CAD in hyperten sive patients with LVH [45]. Using thallium imaging it has been shown that HYP patients with LVH have a high prevalence of both silent and symptomatic CAD [46]. For this aim, two groups of patients have been compared tak ing into consideration the age, sex.…”

Ischemia and fibrosis: the risk mechanisms of hypertensive heart disease

“…The increased total peripheral resistance in hypertension is shared by all organ circulations including the coronary one. Consequently, Marcus and associates (8) introduced the concept of coronary flow reserve which has been extremely useful to explain coronary insufficiency and silent ischemia associated with hypertensive heart disease (HHD) and other cardiovascular diseases (8)(9)(10)29). Using this innovation, coronary blood flow is measured before and after physiological (e.g., exercise, ventricular pacing) or pharmacological (e.g., carbochrome, papaverine, dipyridamole, adenosine) interventions, and the difference between the two coronary blood flow and vascular resistance measurements provides an excellent index of coronary flow reserve and minimal coronary vascular resistance.…”

Assessment of relationship between galectin-3 and ambulatory ECG-based microvolt T-wave alternans in sustained systolic-diastolic hypertension patients

“…Myocardial ischemia is one of the important causes of arrhythmia and MTWA positivity [17]. Changes associated with hypertension in myocardium, arterial walls, coronary artery diameter, and blood viscosity may lead to myocardial ischemia by causing supply-demand mismatches in coronary blood flow [18][19][20][21]. Other than fibrosis and ischemia, adrenergic neural activation also plays a significant role in life-threatening cardiac arrhythmias and sudden death in hypertensive patients [22].…”