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[Detection of silent ischemia in hypertensive subjects with high vascular risk using continuous electrocardiogram in
L D Nguyen1, J Julien, S K Abir
1Service d'hypertension artérielle, hôpital Broussais, Paris, France.
Insights
Repolarisation abnormalities on resting ECG predict more frequent ST-T downslopping (STD) in high-risk hypertensive men. This suggests silent ischemia, potentially explaining excess cardiovascular mortality in hypertension.
Area of Science:
- Cardiology
- Clinical Electrophysiology
- Hypertension Research
Context:
- Systemic hypertension is a major risk factor for cardiovascular disease.
- Resting ECG abnormalities can indicate underlying cardiac issues.
- Identifying prognostic markers in high-risk hypertensive patients is crucial for risk stratification.
Purpose:
- To evaluate the prognostic significance of resting ECG repolarisation abnormalities in asymptomatic, high-risk hypertensive men.
- To compare the frequency of significant ST-T downslopping (STD) events detected by ambulatory ECG in hypertensive men with and without resting ECG abnormalities.
Summary:
- This study compared 68 high-risk hypertensive men, stratified by resting ECG findings (R+ vs. R-).
- Patients with resting repolarisation abnormalities (R+) showed a significantly higher frequency of prolonged STD episodes (p < 0.001) on 35-hour ambulatory ECG monitoring.
- Left ventricular mass index was also significantly higher in the R+ group (p < 0.02).
Impact:
- The findings suggest that resting ECG repolarisation abnormalities are associated with a higher burden of silent myocardial ischemia in high-risk hypertensive patients.
- ST-T downslopping (STD) may serve as a marker for silent ischemia, contributing to the increased cardiovascular mortality observed in hypertensive individuals with ST-T abnormalities.
- This research highlights the prognostic value of combining resting ECG with ambulatory monitoring for risk assessment in hypertension.
Unlabelled:
To assess the prognostic value of ECG repolarisation abnormalities (negative T wave and/or ST downslopping (STD) less than 0.1 mV) in systemic hypertension, we compared the frequency of STD greater than or equal to 0.1 mV and greater than 40 s (Qmed real-time ambulatory ECG system) in asymptomatic high-risk hypertensive men with or without ST-T abnormalities on resting ECG (less than or equal to 0 T wave and less than 1 mm ST downslopping). Among 68 hypertensive patients in the upper quintile of risk distribution according to the Paris prospective study, 32 were R+ and 36 R-. Mean age (R+ 53, R- 53 yrs), blood pressure (R+ 180/106, R- 175/102 mmHg), body-mass index (R+ 27, R- 28 kg/m2) risk score (R+ 5.8, R- 5.4), and Sokolow index (R+ 2.7, R- 2.5 mV) were similar in both groups. Left ventricular mass index was different (R+ 152, R- 118 gr/m2, p less than 0.02). Mean recording duration was 35 hours. Eighty-nine episodes of STD were detected in 7 R+ patients (lasting 3 to 136 mn) and one R- patient (lasting 60 s), p less than 0.001. Echographic LVH was present in the 7 positive patients of the group R+. 6 patients underwent thallium scanning and/or coronary angiography: thallium was positive in 4 patients; coronary artery angiography was performed in 3 patients, showing bitroncular stenosis in 1 patient.
Conclusion:
in the present group of high-risk asymptomatic hypertensive patients, the frequency of STD was higher (p = 0.05) in the presence of repolarisation abnormalities on the resting ECG. STD suggests silent ischemia and could account for the excess of cardio-vascular mortality connected with ST-T abnormalities in hypertension.