Thallium-201 stress imaging in hypertensive patients.

Abstract

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.

Dipyridamole echocardiography in essential hypertensive patients with chest pain.

“…This is particularly true in the presence of left ventricular hypertrophy, which makes an EET uninterpretable. 2 Unfortunately, alternative stressing procedures, such as exercise radionuclide angiography 3 and thallium-201 stress imaging, 4 were found to be inadequate screening tests for CAD because of the frequent occurrence of false-positive responses.…”

Left ventricular dysfunction and HLA Bw52 antigen in Takayasu arteritis

“…They found that 20 of the 38 patients (53%) had perfusion abnormalities which were responsible for a decrease in coronary reserve, myocardial damage, or both, due to long-standing systemic hypertension or to aortic regurgitation. They also pointed out that the mechanism of the perfusion abnormalities in these patients with arteritis was the same as that seen in patients with hypertrophic cardiomyopathy [16] or hypertensive heart disease [17].…”

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

“…Для гипертонического поражения сердца типично снижение ранней скоро-сти диастолического наполнения (е'), определенной без выраженных симптомов, характерных для ИБС с окклюзией. Если результаты ЭКГ с физической нагрузкой положительны или не могут быть интерпре-тированы (неоднозначны), то для надежной диагно-стики ишемии миокарда требуется методика, позволя-ющая визуализировать появление ишемии, например, стресс-МРТ сердца, перфузионная сцинтиграфия или стресс-эхокардиография [178][179][180]. Индуцированные стрессом нарушения подвижности стенок желудочка высокоспецифичны для стеноза эпикардиальных артерий, подтвержденного ангиографически.…”