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Morphologic, hemodynamic and coronary perfusion characteristics in severe left ventricular hypertrophy secondary to systemic hypertension and evidence for nonatherosclerotic myocardial ischemia

Patients with the clinical diagnosis of ischemic heart disease who were found to be free of significant coronary artery atherosclerotic disease (n = 150) underwent coronary vasodilator reserve testing, 2-dimensional echocardiography, and dipyridamole limited-stress thallium testing. After exclusions... Full description

Journal Title: The American journal of cardiology 1992, Vol.69 (3), p.219-224
Main Author: Houghton, Jan Laws
Other Authors: Carr, Albert A , Prisant, L.Michael , Rogers, Ward B , von Dohlen, Thomas W , Flowers, Nancy C , Frank, Martin J
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: New York, NY: Elsevier Inc
ID: ISSN: 0002-9149
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recordid: cdi_proquest_miscellaneous_72787830
title: Morphologic, hemodynamic and coronary perfusion characteristics in severe left ventricular hypertrophy secondary to systemic hypertension and evidence for nonatherosclerotic myocardial ischemia
format: Article
creator:
  • Houghton, Jan Laws
  • Carr, Albert A
  • Prisant, L.Michael
  • Rogers, Ward B
  • von Dohlen, Thomas W
  • Flowers, Nancy C
  • Frank, Martin J
subjects:
  • Abridged Index Medicus
  • Adult
  • Aged
  • Analysis of Variance
  • Arterial hypertension. Arterial hypotension
  • Biological and medical sciences
  • Blood and lymphatic vessels
  • Cardiology. Vascular system
  • Cardiomegaly - diagnosis
  • Cardiomegaly - etiology
  • Cardiomegaly - pathology
  • Cardiomegaly - physiopathology
  • Clinical manifestations. Epidemiology. Investigative techniques. Etiology
  • Coronary Artery Disease - diagnosis
  • Coronary Circulation
  • Coronary heart disease
  • Diagnosis
  • Diagnosis, Differential
  • Echocardiography
  • Female
  • Humans
  • Hypertension
  • Hypertension - complications
  • Hypertrophy
  • Male
  • Medical sciences
  • Middle Aged
  • Physiological aspects
  • Thallium Radioisotopes
  • Vascular Resistance
ispartof: The American journal of cardiology, 1992, Vol.69 (3), p.219-224
description: Patients with the clinical diagnosis of ischemic heart disease who were found to be free of significant coronary artery atherosclerotic disease (n = 150) underwent coronary vasodilator reserve testing, 2-dimensional echocardiography, and dipyridamole limited-stress thallium testing. After exclusions (predominantly for technically poor coronary artery Doppler signals or suboptimal echocardiography), 100 patients formed the study population. The purpose was to characterize typical cardiac and coronary artery findings in hypertensive patients with severe left ventricular (LV) hypertrophy (n = 15) and to investigate the evidence for myocardial ischemia unrelated to coronary atherosclerosis in early and advanced hypertensive heart disease. Normotensive and hypertensive control groups without LV hypertrophy (n = 12 and 34, respectively) were used for comparison. Severe LV hypertrophy was defined as LV mass index ≥50% above established gender specific norms using 2-dimensional-directed M-mode echocardiography and the cube equation corrected to agree with necropsy estimates of mass. Clinical characteristics more often associated with severe LV hypertrophy were black race (67%), diabetes mellitus (33%), proteinuria (47%) and elevated creatinine (1.5 ± 0.9 mg/dl). Baseline electrocardiograms and dipyridamole limited-stress thallium scans were highly likely to be abnormal (94 and 73%, respectively). Both eccentric and concentric cardiac hypertrophies were found in the severe group. Ejection fraction was significantly lower (0.51 vs 0.68, p = 0.002) and basal coronary flow velocity higher (12.0 vs 5.0 cm/s, p = 0.0004) among these patients when compared with normotensive control patients. Coronary flow reserve did not differ between control groups but was significantly depressed in patients with severe LV hypertrophy (2.5 vs 3.9, p = 0.001). This, together with the prevalent evidence of resting and stress-induced ischemia, strongly supports the concept of myocardial ischemia unrelated to coronary atherosclerosis in this group.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0002-9149
fulltext: fulltext
issn:
  • 0002-9149
  • 1879-1913
url: Link


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titleMorphologic, hemodynamic and coronary perfusion characteristics in severe left ventricular hypertrophy secondary to systemic hypertension and evidence for nonatherosclerotic myocardial ischemia
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creatorHoughton, Jan Laws ; Carr, Albert A ; Prisant, L.Michael ; Rogers, Ward B ; von Dohlen, Thomas W ; Flowers, Nancy C ; Frank, Martin J
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descriptionPatients with the clinical diagnosis of ischemic heart disease who were found to be free of significant coronary artery atherosclerotic disease (n = 150) underwent coronary vasodilator reserve testing, 2-dimensional echocardiography, and dipyridamole limited-stress thallium testing. After exclusions (predominantly for technically poor coronary artery Doppler signals or suboptimal echocardiography), 100 patients formed the study population. The purpose was to characterize typical cardiac and coronary artery findings in hypertensive patients with severe left ventricular (LV) hypertrophy (n = 15) and to investigate the evidence for myocardial ischemia unrelated to coronary atherosclerosis in early and advanced hypertensive heart disease. Normotensive and hypertensive control groups without LV hypertrophy (n = 12 and 34, respectively) were used for comparison. Severe LV hypertrophy was defined as LV mass index ≥50% above established gender specific norms using 2-dimensional-directed M-mode echocardiography and the cube equation corrected to agree with necropsy estimates of mass. Clinical characteristics more often associated with severe LV hypertrophy were black race (67%), diabetes mellitus (33%), proteinuria (47%) and elevated creatinine (1.5 ± 0.9 mg/dl). Baseline electrocardiograms and dipyridamole limited-stress thallium scans were highly likely to be abnormal (94 and 73%, respectively). Both eccentric and concentric cardiac hypertrophies were found in the severe group. Ejection fraction was significantly lower (0.51 vs 0.68, p = 0.002) and basal coronary flow velocity higher (12.0 vs 5.0 cm/s, p = 0.0004) among these patients when compared with normotensive control patients. Coronary flow reserve did not differ between control groups but was significantly depressed in patients with severe LV hypertrophy (2.5 vs 3.9, p = 0.001). This, together with the prevalent evidence of resting and stress-induced ischemia, strongly supports the concept of myocardial ischemia unrelated to coronary atherosclerosis in this group.
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subjectAbridged Index Medicus ; Adult ; Aged ; Analysis of Variance ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cardiomegaly - diagnosis ; Cardiomegaly - etiology ; Cardiomegaly - pathology ; Cardiomegaly - physiopathology ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Coronary Artery Disease - diagnosis ; Coronary Circulation ; Coronary heart disease ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Female ; Humans ; Hypertension ; Hypertension - complications ; Hypertrophy ; Male ; Medical sciences ; Middle Aged ; Physiological aspects ; Thallium Radioisotopes ; Vascular Resistance
ispartofThe American journal of cardiology, 1992, Vol.69 (3), p.219-224
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descriptionPatients with the clinical diagnosis of ischemic heart disease who were found to be free of significant coronary artery atherosclerotic disease (n = 150) underwent coronary vasodilator reserve testing, 2-dimensional echocardiography, and dipyridamole limited-stress thallium testing. After exclusions (predominantly for technically poor coronary artery Doppler signals or suboptimal echocardiography), 100 patients formed the study population. The purpose was to characterize typical cardiac and coronary artery findings in hypertensive patients with severe left ventricular (LV) hypertrophy (n = 15) and to investigate the evidence for myocardial ischemia unrelated to coronary atherosclerosis in early and advanced hypertensive heart disease. Normotensive and hypertensive control groups without LV hypertrophy (n = 12 and 34, respectively) were used for comparison. Severe LV hypertrophy was defined as LV mass index ≥50% above established gender specific norms using 2-dimensional-directed M-mode echocardiography and the cube equation corrected to agree with necropsy estimates of mass. Clinical characteristics more often associated with severe LV hypertrophy were black race (67%), diabetes mellitus (33%), proteinuria (47%) and elevated creatinine (1.5 ± 0.9 mg/dl). Baseline electrocardiograms and dipyridamole limited-stress thallium scans were highly likely to be abnormal (94 and 73%, respectively). Both eccentric and concentric cardiac hypertrophies were found in the severe group. Ejection fraction was significantly lower (0.51 vs 0.68, p = 0.002) and basal coronary flow velocity higher (12.0 vs 5.0 cm/s, p = 0.0004) among these patients when compared with normotensive control patients. Coronary flow reserve did not differ between control groups but was significantly depressed in patients with severe LV hypertrophy (2.5 vs 3.9, p = 0.001). This, together with the prevalent evidence of resting and stress-induced ischemia, strongly supports the concept of myocardial ischemia unrelated to coronary atherosclerosis in this group.
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7Cardiology. Vascular system
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9Cardiomegaly - etiology
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12Clinical manifestations. Epidemiology. Investigative techniques. Etiology
13Coronary Artery Disease - diagnosis
14Coronary Circulation
15Coronary heart disease
16Diagnosis
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18Echocardiography
19Female
20Humans
21Hypertension
22Hypertension - complications
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25Medical sciences
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titleMorphologic, hemodynamic and coronary perfusion characteristics in severe left ventricular hypertrophy secondary to systemic hypertension and evidence for nonatherosclerotic myocardial ischemia
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7Cardiology. Vascular system
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20Humans
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abstractPatients with the clinical diagnosis of ischemic heart disease who were found to be free of significant coronary artery atherosclerotic disease (n = 150) underwent coronary vasodilator reserve testing, 2-dimensional echocardiography, and dipyridamole limited-stress thallium testing. After exclusions (predominantly for technically poor coronary artery Doppler signals or suboptimal echocardiography), 100 patients formed the study population. The purpose was to characterize typical cardiac and coronary artery findings in hypertensive patients with severe left ventricular (LV) hypertrophy (n = 15) and to investigate the evidence for myocardial ischemia unrelated to coronary atherosclerosis in early and advanced hypertensive heart disease. Normotensive and hypertensive control groups without LV hypertrophy (n = 12 and 34, respectively) were used for comparison. Severe LV hypertrophy was defined as LV mass index ≥50% above established gender specific norms using 2-dimensional-directed M-mode echocardiography and the cube equation corrected to agree with necropsy estimates of mass. Clinical characteristics more often associated with severe LV hypertrophy were black race (67%), diabetes mellitus (33%), proteinuria (47%) and elevated creatinine (1.5 ± 0.9 mg/dl). Baseline electrocardiograms and dipyridamole limited-stress thallium scans were highly likely to be abnormal (94 and 73%, respectively). Both eccentric and concentric cardiac hypertrophies were found in the severe group. Ejection fraction was significantly lower (0.51 vs 0.68, p = 0.002) and basal coronary flow velocity higher (12.0 vs 5.0 cm/s, p = 0.0004) among these patients when compared with normotensive control patients. Coronary flow reserve did not differ between control groups but was significantly depressed in patients with severe LV hypertrophy (2.5 vs 3.9, p = 0.001). This, together with the prevalent evidence of resting and stress-induced ischemia, strongly supports the concept of myocardial ischemia unrelated to coronary atherosclerosis in this group.
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pubElsevier Inc
pmid1530994
doi10.1016/0002-9149(92)91308-Q