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Hypertension and ischemic heart disease. Role of dipyridamole echocardiography test
M M Gulizia1, P Lo Giudice, G Doria
1Cardiology and Hypertension Centre, S. Currò e S. Luigi G. Hospital, U.S.L. Catania, Italy.
Insights
Hypertension patients with dipyridamole-induced ST depression, a sign of potential ischemic heart disease, had higher left ventricular mass and longer hypertension duration. This suggests a worse prognosis for hypertensive individuals with this specific cardiac response.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Arterial hypertension is a significant risk factor for ischemic heart disease (IHD).
- Assessing IHD risk in hypertensive patients requires understanding their physiopathologic response to stress tests.
- Dipyridamole echocardiography test (DET) can reveal myocardial ischemia.
Purpose of the Study:
- To evaluate the relationship between arterial hypertension and IHD.
- To analyze the physiopathologic response to DET in hypertensive patients without baseline ECG changes.
- To identify factors associated with ischemic-like responses during DET in this population.
Main Methods:
- Sixty mild-to-moderate asymptomatic hypertensive patients underwent high-dose DET.
- Patients were in pharmacologic washout and had no resting or exercise-induced ST depression.
- Left ventricular mass index (LVMI) and hypertension duration were compared between groups with and without DET-induced ST depression.
Main Results:
- 30% of patients (18/60) exhibited ST segment depression during DET.
- These patients had significantly higher LVMI (160.2 vs 129.2 g/m2) and longer hypertension duration (30 vs 9 months).
- No significant coronary artery obstruction was found angiographically in any patient.
Conclusions:
- "Ischemic-like" ST depression during DET in hypertensive patients may indicate a worse prognosis.
- This phenomenon might be linked to increased coronary resistance from structural modifications or anatomical factors.
- DET can reveal subclinical cardiac issues in hypertensive patients, potentially predicting future IHD events.
Abstract:
The aim of this study is to try to evaluate the relationship between arterial hypertension and ischemic heart disease (IHD) in the light of the physiopathologic response pattern to the dipyridamole echocardiography test (DET) in hypertensive patients, in pharmacologic washout, without any electrocardiographic ST segment depression during exercise tests or at rest. Sixty patients affected by mild to moderate asymptomatic essential arterial hypertension were studied: the subjects had a sitting diastolic blood pressure > or = 95 < or = 114 mmHg; there were 38 men and 22 women with a mean age of 49.8 +/- 7.6 years (range twenty-nine to sixty-eight). All patients had undergone high-dose DET (0.84 mg/kg in ten minutes). No patients developed side effects or asynergy in cardiac contractility during the test. In the absence of any significant coronary artery obstruction assessed angiographically, 18 patients (30%) showed ST segment depression > 1.0 mV during DET, sometimes with the presence of ventricular and/or supraventricular extrasystoles. In this group of patients the left ventricular mass index (LVMI) and duration of hypertension (in months) were higher as compared with those of the other 42 patients (respectively: 160.2 +/- 5.1 vs 129.2 +/- 9.2 g/m2, P < 0.02; and 30 +/- 4.8 vs 9 +/- 5.4 months, P < 0.007). In conclusion it is reasonable to speculate from these data that the ischemic-like" dipyridamole-induced ST segment depression, like that shown by patients affected by Syndrome X, might involve a worse prognosis in hypertensive patients. This may be because of increased coronary resistance due to structural modification or anatomic background.