Relation among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease

Houghton, Jan L.; Frank, Martin J.; Carr, Albert A.; Dohlen, Thomas W. von; Prisant, L. Michael

doi:10.1016/0735-1097(90)90173-m

Cited by 304 publications

(101 citation statements)

References 23 publications

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“…Evidence suggests that myocardial fibrosis may impair microvascular coronary reserve, leading to ischaemia. 23 Offering support to this observation is a study which The rate of major CV morbid events was significantly higher in the subset with LVH (with permission from Verdechia et al 6 ).…”

Section: Left Ventricular Strain Pattern As a Prognostic Indicatormentioning

confidence: 95%

The prognostic value of the ECG in hypertension: where are we now?

Ang

Lang

2008

J Hum Hypertens

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In hypertension, the presence of left ventricular hypertrophy (LVH) is associated with increased risk of both cardiovascular morbidity and mortality. To date, the electrocardiogram (ECG) remains the cornerstone of LVH diagnosis in clinical practice because it is universally available, technically easy to perform and highly specific. In the most recent European Society of Hypertension/European Society of Cardiology guidelines for the treatment of arterial hypertension, the Sokolow-Lyon voltage criterion was recommended as part of all routine assessment of subjects with hypertension. However, the use of the ECG in the diagnosis of LVH is somewhat limited by its poor sensitivity. In this review article, we discuss the individual strength and weaknesses of the commonly used ECG criteria in diagnosing LVH. In addition, we present the latest data on the prognostic significance of ECG LVH and the survival differences conferred in different genders. In view of the recent Losartan Intervention for Endpoint Reduction in Hypertension trial, the prognostic benefit of LVH regression will also be addressed. Finally, with the wider availability of echocardiography, the role of combining both modalities to improve risk stratification in hypertension is reviewed.

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Section: Left Ventricular Strain Pattern As a Prognostic Indicatormentioning

confidence: 95%

The prognostic value of the ECG in hypertension: where are we now?

Ang

Lang

2008

J Hum Hypertens

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“…With this regard, early experimental and clinical invasive studies reported association of LVH with reduced CFR. [6][7][8][9][10] However, others failed to find significant independent relationship between CFR and LVH, [11][12][13][14][15][16][17] and the independent relation between LVH and abnormal CFR remains disputed. In addition, LVH is independently associated with coronary artery disease, 18 which may confound the relation between LVH and CFR.…”

Section: Introductionmentioning

confidence: 99%

Relations of left ventricular mass and systolic function to endothelial function and coronary flow reserve in healthy, new discovered hypertensive subjects

et al. 2005

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Left ventricular hypertrophy (LVH) is prognostically relevant, associated with major cardiovascular risk factors and with atherosclerosis. However, whether LVH is independently associated with impaired coronary flow reserve (CFR) and with endothelial dysfunction is disputed. We assessed the relationship of LV mass and systolic function to CFR and endothelial function in new discovered never treated subjects with essential arterial hypertension, but without coronary artery disease or microalbuminuria. LVH, ejection fraction (EF) and stress-corrected midwall shortening (MWS, a measure of myocardial contractility) were assessed by echocardiography. CFR was assessed by single-photon emission computed tomography and dipyridamole infusion. Endothelial function was evaluated by assessing 1-min postischaemic flow-mediated dilatation of the brachial artery (FMD); nitroglycerine-mediated dilatation (NMD) of the same brachial artery was used as measure of nonendothelium-dependent vasodilatation. In approximately 1 year, we enrolled 21 subjects who met stringent inclusion criteria (47710 years old, 26.672.8 kg/m 2 , 78% men). Five patients showed LVH. Multivariate analyses showed a significant negative correlation of LV mass index with FMD (b ¼ À0.61, Po0.05) but not with NMD, neither with CFR. Stress-corrected MWS showed independent correlation with CFR (b ¼ 0.51, Po0.05). Thus, in clinically healthy, new discovered hypertensive subjects, never treated and mostly in the early stage of arterial hypertension, LVH can be associated with endothelial dysfunction while maximal dipyridamoledependent CFR may be preserved; nevertheless, a cardiac phenotype presenting with tendency to impaired myocardial contractility, assessed by stress-corrected MWS, showed association with lower CFR in the early stage of arterial hypertension.

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“…In patients with left ventricular hypertrophy (LVH), it has been reported that myocardial ischemia may occur in the absence of epicardial coronary artery disease (1)(2)(3)(4)(5). It has been suggested that an imbalance between oxygen supply and demand due to the greatly increased myocardial mass might be a mechanism for myocardial ischemia (6).…”

Section: Introductionmentioning

confidence: 99%