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Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy
S D Pringle1, F G Dunn, A C Tweddel
1University Department of Medical Cardiology, Royal Infirmary, Glasgow.
Insights
Symptomatic and silent myocardial ischemia are frequent in patients with hypertensive left ventricular hypertrophy. Many cases of ischemia occur without chest pain, highlighting the need for thorough cardiac evaluation.
Area of Science:
- Cardiology
- Hypertension Research
- Ischemia Studies
Background:
- Hypertensive left ventricular hypertrophy (LVH) is a significant cardiovascular risk factor.
- Myocardial ischemia, both symptomatic and silent, can occur in patients with LVH.
- Assessing the prevalence of ischemia is crucial for risk stratification and management.
Purpose of the Study:
- To determine the prevalence of symptomatic and silent myocardial ischemia.
- To investigate ischemia in patients specifically with hypertensive left ventricular hypertrophy.
Main Methods:
- A cross-sectional study was conducted.
- 90 patients with hypertensive LVH underwent 48-hour ambulatory ST segment monitoring.
- Additional assessments included exercise electrocardiography, stress thallium scintigraphy, and coronary arteriography.
Main Results:
- 43 patients showed ST segment depression on monitoring, with over 90% being clinically silent.
- Exercise tests and scintigraphy revealed ischemia in a significant number of patients, often without typical chest pain.
- Coronary arteriography identified significant coronary artery disease in 18 patients, seven of whom were asymptomatic.
Conclusions:
- Symptomatic and silent myocardial ischemia are prevalent in patients with hypertensive left ventricular hypertrophy.
- Ischemia can occur even in the absence of significant epicardial coronary artery disease.
- These findings underscore the importance of detecting ischemia in this patient population.
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.