Aim: In the risk stratification of hypertensive patients exercise ECG is affected by low specificity of ST-segment modifications and the clinical value of stress-related LV volumes changes in these subjects is not well established. So we try to evaluate, in a group of patients showing hypertensive response to exercise and normal perfusion pattern, the impact of stress high systolic pressure levels on gated-SPECT (GS) LVEF and volumes data. Material and Methods: We considered 1317 subjects without CAD history, all with a normal perfusion pattern at myocardial GS. A 99mTc-sestamibi GS 2-day protocol was adopted starting stress acquisition 10 min after peak exercise tracer injection. EDV, ESV and LVEF values were assessed by QGS and changes were statistically analyzed as differential (D) data (“stress value” minus “rest value”). Results: The hypertensive group (A) consisted of 211 patients (16%) showing systolic pressure values ≥200mmHg at injection time. The remaining 1106 subjects with peak systolic values <200mmHg were considered normotensive (group B). D-values in group A vs group B for EDV, ESV and LVEF were respectively: -2.98±6.2 vs -3.04±5.6 (p=ns), 0.51±4.4 vs -1.87±4.7 (p<0.01) and -1.19±3.3 vs 1.88±2.9 (p<0.01). Conclusion: Our data show that in normal perfusion studies acquired early after an hypertensive ergometric stress a reduction in LVEF in comparison to rest imaging is a common finding. This phenomenon, mainly related to a decrease in EDV rather than in ESV occurring in these patients may be due to the high intra-aortic pressure that cause an early closing of the aortic valve limiting optimal LV systolic emptying. This pattern, persisting for some time after ergometric stress ending, may be a paraphysiological finding rather than a post-ischemic stunning expression and, if confirmed in larger trials, must be taken into account also in the evaluation of patients with CAD.
Role of post-stress LVEF and volumes in subjects with hypertensive response to exercise and normal myocardial perfusion pattern: a gated-SPECT evaluation study.
CITTANTI, Corrado;GIGANTI, Melchiore;CECONI, Claudio;
2010
Abstract
Aim: In the risk stratification of hypertensive patients exercise ECG is affected by low specificity of ST-segment modifications and the clinical value of stress-related LV volumes changes in these subjects is not well established. So we try to evaluate, in a group of patients showing hypertensive response to exercise and normal perfusion pattern, the impact of stress high systolic pressure levels on gated-SPECT (GS) LVEF and volumes data. Material and Methods: We considered 1317 subjects without CAD history, all with a normal perfusion pattern at myocardial GS. A 99mTc-sestamibi GS 2-day protocol was adopted starting stress acquisition 10 min after peak exercise tracer injection. EDV, ESV and LVEF values were assessed by QGS and changes were statistically analyzed as differential (D) data (“stress value” minus “rest value”). Results: The hypertensive group (A) consisted of 211 patients (16%) showing systolic pressure values ≥200mmHg at injection time. The remaining 1106 subjects with peak systolic values <200mmHg were considered normotensive (group B). D-values in group A vs group B for EDV, ESV and LVEF were respectively: -2.98±6.2 vs -3.04±5.6 (p=ns), 0.51±4.4 vs -1.87±4.7 (p<0.01) and -1.19±3.3 vs 1.88±2.9 (p<0.01). Conclusion: Our data show that in normal perfusion studies acquired early after an hypertensive ergometric stress a reduction in LVEF in comparison to rest imaging is a common finding. This phenomenon, mainly related to a decrease in EDV rather than in ESV occurring in these patients may be due to the high intra-aortic pressure that cause an early closing of the aortic valve limiting optimal LV systolic emptying. This pattern, persisting for some time after ergometric stress ending, may be a paraphysiological finding rather than a post-ischemic stunning expression and, if confirmed in larger trials, must be taken into account also in the evaluation of patients with CAD.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
