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Noninvasive techniques to assess myocardial ischemia in hypertensive patients.
MedLine Citation:
PMID:  19804351     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Hypertensive patients are more affected by coronary artery disease (CAD) than normotensive patients. Currently, established techniques are able to diagnose myocardial ischemia/CAD in hypertensive patients with suspected CAD. An irrevocable role remains for exercise electrocardiogram (ECG) owing to the many parameters evaluated under physiologic conditions. However, the suboptimal specificity of a positive exercise ECG demands further examination of hypertensive patients with either myocardial single-photon emission computed tomography (SPECT) or stress echocardiography, both more specific than exercise ECG in diagnosing CAD. The high specificity of imaging techniques also makes them highly predictive of cardiac events. Additional techniques to help diagnose CAD are available. Tissue Doppler imaging, strain and other echo-derived techniques may add quantitative elements to recognize CAD in hypertensive hearts. The accuracy of MRI is improving to study myocardial function and perfusion. Positron emission tomography and multislice computed tomography, also in-built with fusion scanners, are playing roles in combining coronary angiography and myocardial function/ischemia assessment. However, no significant application of these additional techniques is available for hypertensive patients. Epicardial CAD assessed by coronary angiography remains the gold standard to decide for revascularization procedures. The presence of microcirculatory dysfunction, a symptom typical of hypertensive hearts, is opening up new areas of noninvasive diagnostic techniques for the detection of coronary flow reserve (CFR) and related myocardial ischemia. The quantification of CFR may render this parameter pivotal to deciding the need for revascularization procedures of intermediate coronary stenosis and it may become an additional gold standard in evaluating coronary vessels. Moreover, even with normal epicardial coronary arteries, microcirculation dysfunction bears prognostic stratification capabilities for hypertensive patients and it may become a promising therapeutic target in the near future.
Authors:
Riccardo Rambaldi; Riccardo Bigi; Cesare Fiorentini
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Future cardiology     Volume:  4     ISSN:  1744-8298     ISO Abbreviation:  Future Cardiol     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2009-10-06     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101239345     Medline TA:  Future Cardiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  569-81     Citation Subset:  -    
Affiliation:
Maggiore Hospital, Bologna, Department of Cardiology, Bologna, Italy. ricram@iol.it.
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