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Pathophysiologic assessment of left ventricular hypertrophy and strain in asymptomatic patients with essential
S D Pringle1, P W Macfarlane, J H McKillop
1University Department of Medical Cardiology, Royal Infirmary, Glasgow, Scotland.
Insights
Essential hypertension patients with electrocardiographic (ECG) left ventricular hypertrophy and strain show covert coronary artery disease. Thallium scintigraphy can detect this hidden condition, highlighting increased cardiovascular risk.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Essential hypertension is a major risk factor for cardiovascular disease.
- Electrocardiographic (ECG) patterns of left ventricular hypertrophy and strain are associated with increased cardiovascular risk.
- The underlying causes of this increased risk in hypertensive patients with specific ECG findings require further investigation.
Purpose of the Study:
- To investigate the significance of the electrocardiographic (ECG) pattern of left ventricular hypertrophy and strain in asymptomatic essential hypertensive patients.
- To determine if this ECG pattern is associated with covert coronary artery disease.
- To explore the utility of thallium perfusion scintigraphy in detecting such abnormalities.
Main Methods:
- Comparison of two groups of asymptomatic essential hypertensive patients (n=23 each) with and without the ECG pattern of left ventricular hypertrophy and strain.
- Assessment of exercise-induced ST segment depression and thallium perfusion abnormalities.
- 24-hour ambulatory ECG monitoring and coronary arteriography in a subset of patients.
Main Results:
- Patients with the ECG pattern exhibited significantly more exercise-induced ST segment depression and reversible thallium perfusion abnormalities.
- Nonsustained ventricular tachycardia was detected in two patients with the ECG pattern.
- Coronary arteriography revealed significant coronary artery disease in 8 of 20 patients with the ECG pattern.
Conclusions:
- A subgroup of hypertensive patients with ECG left ventricular hypertrophy and strain have covert coronary artery disease.
- Thallium perfusion scintigraphy can identify these patients.
- The presence of covert coronary artery disease may contribute to the increased cardiovascular risk associated with this ECG abnormality.
Abstract:
To investigate the significance of the electrocardiographic (ECG) pattern of left ventricular hypertrophy and strain, two groups of asymptomatic patients with essential hypertension were compared. The patients were similar in terms of age, smoking habit, serum cholesterol and blood pressure levels, but differed in the presence (Group I, n = 23) or absence (Group II, n = 23) of the ECG pattern of left ventricular hypertrophy and strain. Group I patients had significantly more episodes of exercise-induced ST segment depression (14 versus 4, p less than 0.05) and reversible thallium perfusion abnormalities (11 of 23 versus 3 of 23, p less than 0.05) despite similar exercise capacity and absence of chest pain. Nonsustained ventricular tachycardia was detected on 24 h ambulatory ECG monitoring in two patients in Group I, but no patient in Group II. Coronary arteriography performed in 20 Group I patients demonstrated significant coronary artery disease in 8 patients. This study has shown that there is a subgroup of hypertensive patients with ECG left ventricular hypertrophy and strain who have covert coronary artery disease. This can be detected by thallium perfusion scintigraphy, and may contribute to the increased risk known to be associated with this ECG abnormality.