Lucarini A R, Lattanzi F, Picano E, De Prisco F, Distante A, L'Abbate A, Salvetti A
Clinica Medica I, University of Pisa, Italy.
Am J Hypertens. 1989 Feb;2(2 Pt 1):120-3. doi: 10.1093/ajh/2.2.120.
Microvascular angina--chest pain syndrome in the presence of angiographically normal epicardial coronary arteries and reduced flow reserve--has been described in patients with essential hypertension (EH) and linked to the development of left ventricular hypertrophy (LVH). We performed a dipyridamole-echocardiography test (DET: 2D-echo and 12 lead ECG monitoring with dipyridamole infusion, up to 0.84 mg/kg over ten minutes) in 28 essential hypertensives meeting the following inclusion criteria: (1) history of chest pain; (2) angiographically normal coronary arteries; (3) normal resting regional and global left ventricular function. A group of 12 (age- and sex-matched) normotensives with the same inclusion criteria, as well as with negative exercise stress test, was also evaluated. During DET, none of the essential hypertensives or the control group developed a regional dyssynergy of contraction. Fifteen essential hypertensives and two in the control group had a diagnostic (greater than 0.1 mV from baseline) ST segment depression on ECG tracing (54 v 17%, P less than .01); 16 essential hypertensives and two in the control group had chest pain (57 v 17%, P less than .01). None of the control group and nine of the essential hypertensives had echocardiographically assessed LVH. In the essential hypertensive group ventricular hypertrophy was present in seven of 20 patients with and in two of eight patients without dipyridamole induced chest pain and/or ST segment depression (35% v 25%, P = NS). In conclusion, essential hypertensive patients with chest pain and angiographically normal coronary arteries frequently show echocardiographically silent angina and/or ST segment depression during DET.(ABSTRACT TRUNCATED AT 250 WORDS)
微血管性心绞痛——一种在冠状动脉造影显示心外膜冠状动脉正常但血流储备降低时出现的胸痛综合征——已在原发性高血压（EH）患者中被描述，并与左心室肥厚（LVH）的发生有关。我们对28名符合以下纳入标准的原发性高血压患者进行了双嘧达莫超声心动图检查（DET：静脉输注双嘧达莫，10分钟内剂量达0.84mg/kg，同时进行二维超声心动图和12导联心电图监测）：（1）有胸痛病史；（2）冠状动脉造影正常；（3）静息时局部和整体左心室功能正常。还评估了一组12名（年龄和性别匹配）符合相同纳入标准且运动应激试验阴性的血压正常者。在DET期间，原发性高血压患者或对照组均未出现局部收缩不协调。15名原发性高血压患者和2名对照组患者在心电图上出现诊断性（较基线压低大于0.1mV）ST段压低（54%对17%，P<0.01）；16名原发性高血压患者和2名对照组患者出现胸痛（57%对17%，P<0.01）。对照组中无人出现超声心动图评估的LVH，原发性高血压组中有9人出现。在原发性高血压组中，20名出现双嘧达莫诱发胸痛和/或ST段压低的患者中有7人出现心室肥厚，8名未出现者中有2人出现（35%对25%，P=无显著性差异）。总之，有胸痛且冠状动脉造影正常的原发性高血压患者在DET期间常出现超声心动图隐匿性心绞痛和/或ST段压低。（摘要截短于250字）
