Diagnosis of myocardial ischemia in hypertensive patients

Area of Science:

• Cardiology
• Hypertension Research
• Diagnostic Imaging

Background:

• Arterial hypertension can reduce coronary flow reserve through multiple, non-exclusive mechanisms.
• These include epicardial coronary artery disease (CAD), left ventricular hypertrophy, and microvascular dysfunction.
• Different diagnostic approaches are necessary to identify these distinct pathological targets.

Purpose of the Study:

• To outline the mechanisms by which arterial hypertension affects coronary flow reserve.
• To differentiate the diagnostic markers for epicardial CAD, left ventricular hypertrophy, and microvascular disease in hypertensive patients.
• To guide the appropriate use of diagnostic testing for coronary artery disease in hypertension.

Main Methods:

• Review of mechanisms linking hypertension to reduced coronary flow reserve.
• Analysis of diagnostic specificity for stress-induced wall motion abnormalities (epicardial CAD) versus ST depression/perfusion abnormalities (LVH/microvascular disease).
• Evaluation of the role of exercise-electrocardiography stress testing and imaging stress echocardiography.

Main Results:

• Stress-induced wall motion abnormalities are specific for epicardial CAD.
• ST depression and perfusion abnormalities often indicate LVH and/or microvascular disease in normal epicardial arteries.
• Exercise-electrocardiography has a high negative predictive value, useful for screening.
• Imaging stress echocardiography is recommended for positive or ambiguous exercise tests to identify significant epicardial CAD.

Conclusions:

• Hypertension-induced coronary flow reduction involves diverse pathologies requiring tailored diagnostics.
• Exercise-electrocardiography is a valuable screening tool, especially for ruling out significant CAD.
• Imaging stress echocardiography is crucial for confirming epicardial CAD and guiding revascularization decisions in hypertensive patients.