Left ventricular hypercontractility in hypertensive patients with anginal pain and normal coronary angiograms.

This study was designed to assess left ventricular contractility in hypertensive patients with normal coronary angiography and anginal pain. An abnormally high percentage of hypertensive patients (approximately 30%) undergoing cardiac catheterization because of anginal pain and/or exercise-induced ST-segment depressions has angiographically normal coronary arteries. Possible reasons for these signs of ischemia include a microvasculopathy, metabolic abnormalities and an increased oxygen consumption as a result of left ventricular hypercontractility which was studied here. Left ventricular volumes and ejection fraction were determined in 50 patients with arterial hypertension (23 men, 27 women, age 60 +/- 8 years, RR 154 +/- 24/91 +/- 12 mm Hg) by cardiac catheterization 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 angiographical data were correlated with age, sex. ECG, echocardiography, laboratory 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 difference was mainly due to a significantly reduced endsystolic left ventricular volume (37.1 +/- 15.3 vs. 47.7 +/- 10.8 ml, p < 0.001); enddiastolic left ventricular volume was not significantly different (140.5 +/- 26.8 vs. 149.0 +/- 27.5 ml, p > 0.1). A hyposystolic form of hypertensive heart disease was not observed in this group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)