Negative stress echocardiographic responses in normotensive and hypertensive patients with angina pectoris, positive exercise stress testing, and normal coronary arteriograms

Objectives-To systematically compare the results of dobutamine stress echoc ardiography in matched groups of hypertensive and normotensive patients wit h anginal chest pain and normal coronary arteriograms (CPNA). Setting-University hospital. Subjects-33 patients with exertional anginal chest pain, a positive exercis e stress ECG, and a completely normal coronary arteriogram; 17 had a histor y of systemic hypertension (14 women; mean (SD) age 57 (6) years), and 16 h ad no hypertensive history (12 women; age 54 (9) years). Methods-Ambulatory ECG monitoring, dobutamine stress echocardiography; and thallium-201 single photon emission computed tomography (SPECT) were perfor med in all subjects. Results-All patients had normal left ventricular systolic function at rest and none fulfilled the criteria for ventricular hypertrophy. Eight normoten sive patients and 10 hypertensive patients had perfusion abnormalities on t hallium SPECT (p = 0.61). Dobutamine infusion reproduced anginal pain in se ven normotensive and seven hypertensive patients (p = 0.88). ST segment dep ression was also recorded in eight normotensive patients and seven hyperten sive patients (p = 0.61). No patient in either group developed regional wal l motion abnormalities during dobutamine stress echocardiography. Conclusions-Neither hypertensive nor normotensive CPNA patients developed r egional wall motion abnormalities during dobutamine stress echocardiography , despite the high prevalence of scintigraphic perfusion defects in both gr oups and the presence of chest pain and ST segment depression. Thus myocard ial ischaemia was not present in either group, or else dobutamine stress ec hocardiography is insensitive to ischaemia caused by microvascular dysfunct ion.