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The antihypertensive treatment effect on left ventricular diastolic function is reflected in exercise
Charalampos I Liakos1, Andreas P Michaelides, Gregory P Vyssoulis
11st Cardiology Department, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
Journal of Electrocardiology
|September 17, 2011
Summary
Antihypertensive treatment significantly reduced the exercise electrocardiographic hump sign and false-positive exercise tests in patients with arterial hypertension. This improvement correlated with enhanced left ventricular diastolic function.
Area of Science:
- Cardiology
- Clinical Medicine
- Hypertension Research
Background:
- The exercise electrocardiographic hump sign is linked to uncontrolled arterial hypertension (AH), left ventricular (LV) diastolic dysfunction, and false-positive exercise tests (ET).
- Understanding the impact of antihypertensive treatment on these markers is crucial for patient management.
Purpose of the Study:
- To prospectively evaluate the effect of antihypertensive treatment on the prevalence of the hump sign and pseudoischemic ST-segment depression.
- To assess potential correlations between these electrocardiographic changes and alterations in LV diastolic function and mass.
Main Methods:
- A prospective study involving 59 never-treated hypertensive patients (mean age 45.9 years).
- Treadmill exercise testing (ET) and echocardiography were performed at baseline and 6 months after achieving blood pressure normalization.
- Measurements included prevalence of hump sign and ST depression, transmitral (E/A) and tissue Doppler (E'/A') early/late velocity ratios, E/E' ratio, and LV mass index (LVMI).
Main Results:
- Hump sign prevalence decreased from 69.5% to 23.7% (P < .05), and false-positive ETs reduced from 35.6% to 18.6% (P < .05).
- Significant improvements were observed in E'/A' ratio (0.68 to 0.84), E/E' ratio (9.3 to 7.9), and LVMI (109.2 to 99.8 g/m²).
- Changes in the hump sign correlated with ST depression changes (r=0.632, P<.001) and LV diastolic indices.
Conclusions:
- Antihypertensive therapy effectively reduces the exercise electrocardiographic hump sign and ST depression suggestive of ischemia.
- These electrocardiographic improvements are likely mediated by enhanced left ventricular diastolic function following blood pressure normalization.
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