Document Detail


Relation between exercise-induced left ventricular wall motion abnormalities and coronary artery disease in hypertensive patients: effects of blood pressure normalization.
MedLine Citation:
PMID:  9056687     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In hypertension, several factors disturb coronary circulation and the metabolic reserve of the heart. This study was undertaken to test whether in hypertensive patients global and regional left ventricular (LV) function is related during exercise to the presence of significant coronary stenosis and whether lowering of coronary perfusion pressure through rapid normalization of the diastolic pressure may modify the dynamics of the left ventricle. Thirty-five patients with mild to moderate hypertension undergoing coronary angiography for the evaluation of chest pain were included in the study; upright bicycle exercise echocardiography tests were performed without therapy and 1 day later 1 h after sublingual administration of nifedipine. LV ejection fraction and regional wall motion scores were evaluated and compared at baseline, peak exercise, immediate postexercise, and recovery phases in each test through digital on-line storing of echocardiographic images. Twenty-one patients had normal coronary arteries (group 1) and 14 significant coronary stenoses (group 2); age, gender, heart rate, blood pressure, left ventricular diameter and mass index, and ejection fraction were similar in the two groups. At peak exercise LV ejection fraction slightly increased in group 1, whereas it slightly decreased in group 2 (both during the test without therapy and after nifedipine administration). All patients in group 1 had normal left ventricular wall motion during exercise; 13 of 14 patients in group 2 had LV wall motion abnormalities at peak exercise. Nifedipine did not produce any effect on LV regional wall motion in group 1, but it induced significant changes in LV regional wall motion in seven patients in group 2. Changes in LV wall motion between the two test groups were related to the number of the stenotic coronary vessels: the normal exercise test before and after therapy and the two normalized tests after nifedipine administration were in fact observed in patients with one-vessel disease, whereas worsening or changes in the site of ischemia were observed only in patients with multivessel disease. Regional and global left ventricular dynamics during exercise is mainly dependent on the existence of significant coronary artery disease. Rapid decrease of blood pressure does not alter the regional dynamics of the left ventricle during exercise in patients without coronary artery disease, but it may induce normalization, worsening, or changes in the site of wall motion abnormalities in hypertensives with significant coronary stenoses.
Authors:
M Pepi; A Maltagliati; M Berti; M Muratori; E Tavasci; B Passaretti; G Tamborini
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  American journal of hypertension     Volume:  10     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-06-04     Completed Date:  1997-06-04     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  297-305     Citation Subset:  IM    
Affiliation:
Istituto di Cardiologia dell'Universitá degli Studi, Fondazione I. Monzino IRCCS, Milan, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure / drug effects,  physiology*
Calcium Channel Blockers / therapeutic use
Coronary Angiography
Coronary Disease / physiopathology*
Echocardiography
Electrocardiography / drug effects
Exercise / physiology*
Exercise Test
Female
Heart Rate / drug effects
Humans
Hypertension / drug therapy,  physiopathology*
Male
Middle Aged
Nifedipine / therapeutic use
Stroke Volume / drug effects
Ventricular Dysfunction, Left / physiopathology*
Chemical
Reg. No./Substance:
0/Calcium Channel Blockers; 21829-25-4/Nifedipine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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