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Left ventricular hypercontractility in hypertensive patients with anginal pain and normal coronary angiograms
M Wehling1, J Camacho, M Christ
1Abteilung für Klinische Pharmakologie, Medizinische Klinik, Klinikum Innenstadt, Universität München.
Insights
Hypertensive patients with chest pain and normal coronary arteries often have increased left ventricular contractility. This hypercontractility, indicated by a higher ejection fraction, may explain their ischemic symptoms despite clear arteries.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiac Physiology
Background:
- A significant portion of hypertensive patients with angina exhibit normal coronary angiography.
- Ischemic symptoms in these patients may stem from microvasculopathy, metabolic issues, or increased cardiac workload.
- Left ventricular hypercontractility is a potential, yet understudied, contributor to myocardial oxygen demand.
Purpose of the Study:
- To investigate left ventricular contractility in hypertensive patients presenting with anginal pain and normal coronary arteries.
- To determine if increased left ventricular ejection fraction is a characteristic feature in this patient subgroup.
- To explore potential underlying mechanisms for ischemia in the absence of obstructive coronary artery disease.
Main Methods:
- Cardiac catheterization and computerized analysis of laevocardiographies were used to assess left ventricular volumes and ejection fraction.
- Fifty hypertensive patients (mean age 60) and 50 normotensive controls (mean age 57) were studied.
- Data were correlated with clinical factors including age, sex, ECG, echocardiography, and medication.
Main Results:
- Hypertensive patients demonstrated a significantly increased left ventricular ejection fraction (75.8% vs. 67.7%, p < 0.001) compared to controls.
- This increase was primarily driven by a significantly reduced end-systolic left ventricular volume.
- End-diastolic left ventricular volume did not differ significantly between the groups.
Conclusions:
- Hypertensive patients with anginal symptoms and normal coronary arteries exhibit enhanced left ventricular contractility.
- Increased left ventricular ejection fraction and reduced end-systolic volume suggest hypercontractility as a factor in their cardiac presentation.
- A hyposystolic pattern of hypertensive heart disease was not identified in this cohort.
Abstract:
This study was designed to assess left ventricular contractility in hypertensive patients with normal coronary angiography and anginal pain. An abnormally high percentage of hypertensive patients (approximately 30%) undergoing cardiac catheterization because of anginal pain and/or exercise-induced ST-segment depressions has angiographically normal coronary arteries. Possible reasons for these signs of ischemia include a microvasculopathy, metabolic abnormalities and an increased oxygen consumption as a result of left ventricular hypercontractility which was studied here. Left ventricular volumes and ejection fraction were determined in 50 patients with arterial hypertension (23 men, 27 women, age 60 +/- 8 years, RR 154 +/- 24/91 +/- 12 mm Hg) by cardiac catheterization and computerized analysis of laevocardiographies. The control group were 50 normotensives (30 men, 20 women, age 57 +/- 12 years, RR 128 +/- 12/76 +/- 8 mm Hg) without coronary artery disease. The angiographical data were correlated with age, sex. ECG, echocardiography, laboratory findings, medication and duration of hypertension. The left ventricular ejection fraction was significantly increased in the group of hypertensives (75.8 +/- 6.3 vs. 67.7 +/- 5.0%, p < 0.001). This difference was mainly due to a significantly reduced endsystolic left ventricular volume (37.1 +/- 15.3 vs. 47.7 +/- 10.8 ml, p < 0.001); enddiastolic left ventricular volume was not significantly different (140.5 +/- 26.8 vs. 149.0 +/- 27.5 ml, p > 0.1). A hyposystolic form of hypertensive heart disease was not observed in this group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)