Left ventricular systolic performance during upright bicycle exercise in patients with essential hypertension

Francis, Charles K.; Cleman, Michael; Berger, Harvey J.; Davies, Ross A.; Giles, R.; Black, Henry R.; Vita, Néstor A.; Zito, Ruben A.; Zaret, Barry L.

doi:10.1016/0002-9343(83)90116-x

Cited by 18 publications

(2 citation statements)

References 32 publications

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“…This has been directly evaluated by means of radionuclide cineangiography at rest and during exercise in several recent studies. 40 ' 41 Among hypertensive patients with no evidence of coronary artery disease, the prevalence of abnormal LV ejection fraction responses to exercise has ranged from 9 of 37 patients (24%) 42 to 15 of 20 patients (75%). 43 Our studies 40 ' 4I indicate that a small proportion -approximately 10% -of the hypertensive patients who exhibit abnormal LV functional reserve can be identified by evidence of impaired myocardial contractility (low echocardiographic fractional shortening in relation to end-systolic stress) at rest; whereas in the remainder, LV dysfunction is only revealed by imposition of exercise stress.…”

Section: Left Ventricular Performancementioning

confidence: 99%

Left ventricular hypertrophy in hypertension. Prevalence and relationship to pathophysiologic variables.

Devereux¹,

Pickering²,

Alderman³

et al. 1987

Hypertension

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SUMMARY In less than a decade since development of echocardiographic measurement of left ventricular muscle mass, studies using this technique have provided considerable information about the prevalence and pathophysiology of left ventricular hypertrophy in human hypertension. Increased left ventricular mass has been found in a significant minority of patients with systemic hypertension, with the exact prevalence dependent both on how a population is selected and on the sex, race, and possibly age composition of its members. All published studies have reported that left ventricular hypertrophy is more closely related to blood pressure recorded in the patient's natural setting during normal activity or exercise -whether measured by portable recorder or home manometer -than to blood pressure measured by the physician. In addition, studies indicate that the classic hypertensive abnormalities of concentric left ventricular hypertrophy and increased peripheral resistance are interrelated, while left ventricular hypertrophy is absent in a subgroup of patients with mild essential hypertension who exhibit high cardiac output and evidence of supernormal myocardial contractility. Conversely, the left ventricular functional response to exercise is inversely related to the degree of hypertrophy. High levels of blood viscosity, which would tend to blunt the reduction in peripheral resistance expected during sleep or exercise, have also been associated with left ventricular hypertrophy in patients with essential hypertension. Echocardiographic studies have provided evidence both for and against the hypothesis that activity of the sympathetic or reninangiotensin systems plays a direct role in causing hypertensive cardiac hypertrophy. These findings demonstrate the useful role that echocardiographic assessment of left ventricular structure and function may play in hypertension research. patients with systemic hypertension -being both a J necessary adaptation to pump a normal amount of blood against the increased pressure load and a pathologic manifestation of hypertensive cardiovascular disease. For many years, knowledge of the complex status of the heart in human hypertension advanced slowly because of the lack of suitable means of measuring cardiac anatomy and function in unselected hypertensive patients or of following their natural history. The development over the last decade of accurate echocardiographic methods for detection of LVH and characterization of ventricular contractile performance has catalyzed an explosion of information about the heart in hypertension.

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Section: Left Ventricular Performancementioning

confidence: 99%

Left ventricular hypertrophy in hypertension. Prevalence and relationship to pathophysiologic variables.

Devereux¹,

Pickering²,

Alderman³

et al. 1987

Hypertension

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show abstract

“…14 " 16 The abnormal thallium-201 perfusion study results may have been related to undetected coronary artery disease in hypertensive patients, increased oxygen demand caused by increased left ventricular mass, 17 inadequate coronary reserve, 18 ' 19 altered hemodynamics, 20 ' 21 or to a combination of these or other, as yet unrecognized, factors. 22 " 24 The increased incidence of abnormal stress test results in hypertensive patients in the absence of angiographic coronary artery disease noted in earlier radionuclide ventriculographic studies 4 and the trends observed in the present study of thallium perfusion may reflect supply-demand imbalance independent of coronary anatomy.…”

Section: Discussionmentioning

confidence: 99%

Thallium-201 stress imaging in hypertensive patients.

Schulman¹,

Francis²,

Black³

et al. 1987

Hypertension

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SUMMARY To assess the potential effect of hypertension on the results of thallium-201 stress imaging in patients with chest pain, 272 thallium-201 stress tests performed in 133 hypertensive patients and 139 normotensive patients over a 1-year period were reviewed. Normotensive and hypertensive patients were similar in age, gender distribution, prevalence of cardiac risk factors (tobacco smoking, hyperlipidemia, and diabetes mellitus), medications, and clinical symptoms of coronary disease. Electrocardiographic criteria for left ventricular hypertrophy were present in 16 hypertensive patients. Stepwise probability analysis was used to determine the likelihood of coronary artery disease for each patient. In patients with mid to high likelihood of coronary disease (>25% probability), abnormal thallium-201 stress images were present in 54 of 60 (90%) hypertensive patients compared with 51 of 64 (80%) normotensive patients. However, in 73 patients with a low likelihood of coronary disease ( s 25% probability), abnormal thallium-201 stress images were present in 21 patients ( SINCE hypertension is a major risk factor for the development of coronary artery disease, the reliability of stress testing for the evaluation of chest pain in patients with abnormal blood pressure elevation is an important clinical concern. Interpretation of routine exercise treadmill testing with electrocardiographic monitoring may be limited in these patients by the presence of baseline electrocardiographic abnormalities associated with left ventricular hypertrophy, medication effects, left bundle branch block, or advanced age. "3 Furthermore, in a study of hypertensive patients with chest pain, exercise radionuclide angiography was found to be an inadequate screening test for coronary artery disease because of the frequent occurrence of false-positive responses. 4 Since stressinduced thallium-201 myocardial defects are a more specific indicator of abnormal regional myocardial perfusion than are electrocardiographic or hemodynamic criteria, exercise testing with thallium-201 imaging may be a more useful test in hypertensive patients. Therefore, thallium-201 stress imaging may be more suited than other diagnostic techniques for the identification of ischemia.5 There is little information concerning the effects of hypertension and possibly associated left ventricular hypertrophy on thallium-201 imaging in patients evaluated for chest pain. To assess the effects of hypertension on the results of thallium-201 stress testing, we reviewed our experience over a 1-year period with normotensive and hypertensive patients who were referred for exercise testing with thallium-201 imaging. The patients were categorized according to their likelihood of having coronary artery disease. We hypothesized that hypertensive patients would have a higher incidence of abnormal thallium-201 imaging than would their normotensive counterparts.

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Nuclear Cardiology

Soufer¹,

Zaret²

1985

Diagnosis and Therapy of Coronary Artery Disease

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Left ventricular systolic performance during upright bicycle exercise in patients with essential hypertension

Cited by 18 publications

References 32 publications

Left ventricular hypertrophy in hypertension. Prevalence and relationship to pathophysiologic variables.

Left ventricular hypertrophy in hypertension. Prevalence and relationship to pathophysiologic variables.

Thallium-201 stress imaging in hypertensive patients.

Nuclear Cardiology

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