LEFT-VENTRICULAR HYPERCONTRACTILITY IN HYPERTENSIVE PATIENTS WITH ANGINAL PAIN AND NORMAL CORONARY ANGIOGRAMS

This study was designed to assess left ventricular contractility in hy pertensive patients with normal coronary angiography and anginal pain. An abnormally high percentage of hypertensive patients (similar to 30 %) undergoing cardiac catheterization because of anginal pain and/or exercise-induced ST-segment depressions has angiographically normal co ronary arteries. Possible reasons for these signs of ischemia include a microvasculopathy, metabolic abnormalities and an increased oxygen c onsumption as a result of left ventricular hypercontractility which wa s studied here. Left ventricular volumes and ejection fraction were de termined in 50 patients with arterial hypertension (23 men, 27 women, age 60 +/- 8 years, RR 154 +/- 24/91 +/- 12 mm Hg) by cardiac catheter ization and computerized analysis of laevocardiographies. The control group were 50 normotensives (30 men, 20 women, age 57 +/- 12 years, RR 128 +/- 12/76 +/- 8 mm Hg) without coronary artery disease. The angio graphical data were correlated with age, sex, ECG, echocardiography, l aboratory findings, medication and duration of hypertension. The left ventricular ejection fraction was significantly increased in the group of hypertensives (75.8 +/- 6.3 vs. 67.7 +/- 5.0 %, p < 0.001). This d ifference was mainly due to a significantly reduced endsystolic left v entricular volume (37.1 +/- 15.3 vs. 47.7 +/- 10,8 ml, p < 0.001); end diastolic left ventricular volume was not significantly different (140 .5 +/- 26.8 vs. 149.0 +/- 27,5 ml, p > 0.1). A hyposystolic form of hy pertensive heart disease was not observed in this group of patients. G rouping of the hypertensives with regard to the duration of hypertensi on resulted in a significant difference for the left ventricular eject ion fraction (77.0 +/- 5.2 for duration greater than or equal to 10 ye ars vs 71.0 +/- 8.5 % for duration < 10 years, p < 0.001). Age, sex, t ype of medication (including analysis for betablockers), ECG-abnormal- ities were not significantly correlated with the left ventricular ejec tion fraction in the hypertensives as determined by linear regression analysis. Left ventricular hypercontractility and a concomitant increa se in oxygen consumption in hypertensive patients with anginal pain an d normal coronary arteries may contribute to the signs of ischemia (ex ercise related ST-segment depression and anginal pain) which lead to c ardiac catheterization under suspicion of coronary heart disease. In t his unique group of hypertensives, hyposystolic, dilative hypertensive heart disease seems to be rare and may reflect other mechanisms of ca rdiac damage.