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Detection of myocardial ischemia in hypertensive patients using dobutamine doppler myocardial imaging echocardiography
124A
POSTERS: Coronary Artery Disease
P-257 DETECTION OF MYOCARDIAL ISCHEMIA IN HYPERTENSIVE PATIENTS USING DOBUTAMINE DOPPLER MYOCARDIAL IMAGING ECHOCARDIOGRAPHY Marina Z. Deljanin Ilic, Stevan N. Ilic, Dragan S. Djordjevic, Dejan S. Petrovic, Ljubisa S. Nikolic, Bojan S. Ilic. Echo Lab, Institute of Cardiology, Niska Banja, University of Nis, Niska Banja, Yugoslavia. The aim of the study was a quantitative assessment of regional systolic and diastolic myocardial velocities (m.v.) changes in the presence of stress induced myocardial ischemia (m.i.) in hypertensive patients (pts) using pulsed wave Doppler myocardial imaging (PW DMI). We studied 67 pts (35 hypertensives, H group and 32 normotensives, N group) with known or suspected coronary artery disease. In all pts dobutamine stress echocardiography (DSE: from 5 up to 40 mcg/kg/min infused in 3 min stages, plus atropine 1 mg if needed) was performed. DSE identified ischemia by the occurrence of wall motion abnormalities (WMA) with stress - positive DSE. Apical views were used to assess m.v. on baseline and at the peak stress. The sample volume was placed in each of 11 adequately visualized segment in which the left ventricle was divided. In each segment peak m.v. of systolic (S), early (E) and late (A) diastolic waves and ratio E/A were calculated. During DSE 88 ischemic myocardial segments in 24 (68.5%) pts in H group were detected, while in 11 pts WMA were not appeared. In N group 63 ischemic segments in 18 (56.2%) pts were detected, while 14 pts had not ischemic response. In segments with DSE provoked WMA, m.v. in H and N group showed: decreased E by 21.7% and 18.3%, increased A by 16.2% and 11.2%, decreased ratio E/A by 32.3% and 26.4% and decreased S by 15.4% and 14.6% compared to baseline values. There were not significant differences in m.v. after DSE in non-ischemic segments between H and N group. Conclusion: Quantification of regional m.v. changes during conventional DSE showed that m.i. is associated with decreased E/A ratio, E and S m.v., and increased A m.v. Changes in diastolic m.v. in segments with DSE provoked m.i. are more pronounced in hypertensive than in normotensive pts. Key Words: Doppler Myocardial Imaging, Stress Echocardiography, Myocardial Ischemia
P-258 THE CLINICAL BENEFITS OF BISOPROLOL ON ANGINA AND QUALITY OF LIFE ARE SIMILAR IN BOTH HYPERTENSIVE AND NORMOTENSIVE PATIENTS Vivencio Barrios, Enrique Galve, Carlos Almeria, Luis M. Ruilope, BISOVID Investigators. Cardiology, Hospital Ramo´ n y Cajal, Madrid, Spain; Cardiology, Hospital Vall d’Hebron, Barcelona, Spain; Cardiology, Hospital Clı´nico, Madrid, Spain; Hypertension Unit, Hospital 12 de Octubre, Madrid. The BISOVID study was performed to assess the influence of the betablocker bisoprolol on the quality of life in patients with post-myocardial infarction stable angina. A total of 150 patients were selected (72% male, age:61⫾11) who were diagnosed of stable angina by a cardiologist after suffering from a myocardial infarction. They received bisoprolol 5-10 mg during 9 months, and were visited quarterly by the specialist. In order to measure health global aspects, the SF-36 quality of life test was performed in each visit. Fifty-nine percent of the patients suffer from hypertension, this condition being more frequent in women (74%) than in men (53%). The number of angina episodes was reduced from 0.9 per week at baseline to 0.2 at the study end. The number of patients experiencing at least one angina episode was also importantly reduced along the study 0895-7061/02/$22.00
AJH–April 2002–VOL. 15, NO. 4, PART 2
(91%, 33%, 14% and 9% at baseline, 3, 6 and 9 months respectively). No difference was observed between hypertensive and normotensive patients. The SF-36 scores were significantly increased (p⬍0.05) along the study, specially the physical and the emotional role, with wider improvements between baseline and the 3 months visits. These differences were also observed within the hypertensive and normotensive subgroups. The global increase in the average score was of 25 points (with a maximum of 51 for the physical role). At the end of the study, the scores were similar for both men and women, and significantly better than at baseline, despite at study onset the score in women was markedly lower. Permanent treatment withdraws was 5.3% and tolerability was high with 3.3% mild-moderate adverse events. The treatment with Bisoprolol in post-myocardial infarction patients with stable angina reduced the number of patients with episodes of angina, the average number of episodes in the global sample of patients, and induced a significant improvement in their quality of life. Treatment effects did not differ between hypertensive and normotensive patients. Key Words: Bisoprolol, Quality of Life, Angina
P-259 CHARACTERISTICS OF PATIENTS WITH CORONARY ARTERY DISEASE AND HYPERTENSION Sridhar R. Vennamaneni, Vinod R. Miryala, Dilip Bearelly. Internal Medicine, Cleveland Clinic Florida, Weston, FL, United States. Coronary artery disease (CAD) is the leading cause of death in the United States. Hypertension is a major risk factor for the development of CAD. We sought to determine the characteristics of patients with CAD and hypertension in patients referred to our hypertension clinic. We performed a retrospective review of the complete medical records of 223 hypertension patients treated at our hypertension Clinic. Charts were reviewed regarding demographic data and covariables obtained were age,sex,body mass index,diabetes,smoking and hypercholesterolemia. Factors associated with CAD were determined by logistic regression analysis. Of 223 patients, 57 patients had CAD (mean age 70.2 years, 56.1% men, 96.4% white). 91.2% patients were on anti-hypertensive treatment. 29.8% were controlled to systolic blood pressure (BP) goal, 87.7% to diastolic BP goal and only 17.5% were controlled to goal blood pressure of ⬍140 mm Hg systolic and ⬍90 mm diastolic. Most patients (38%) were treated with two drugs,24% with three and 14% with four antihypertensive drugs. Of these patients, 45.6% were on beta-blockers,40.3% on calcium channel blockers, 36.1% were on diuretics and 33.3% on ACE inhibitors. Patients with CAD had higher systolic BP and mean arterial pressure (p⬍0.05). Covariates associated with CAD included older age (OR for age 61 to 75 years,2.57, 95% CI 1.11 to 5.99; OR for age ⬎75 years,5.65, 95% CI 2.17 to 14.69, p⫽0.002), body mass index ⬎25 Kg/m2 (OR 2.37, 95% CI 1.15 to 4.86, p⫽0.02) and hypercholesterolemia (OR 2.83, 95% CI 1.31 to 6.11, p⫽0.008). An age of at least 60 years,increased body mass index and hypercholesterolemia are independent predictors for CAD in our sample of hypertension patients. Most cases of uncontrolled hypertension was due to isolated systolic hypertension and most of these patients may need more than 2 drugs to reach goal blood pressure. Key Words: Hypertension, Coronary Artery Disease Predictors, Blood Pressure Control © 2002 by the American Journal of Hypertension, Ltd. Published by Elsevier Science Inc.
POSTERS: Coronary Artery Disease
P-257 DETECTION OF MYOCARDIAL ISCHEMIA IN HYPERTENSIVE PATIENTS USING DOBUTAMINE DOPPLER MYOCARDIAL IMAGING ECHOCARDIOGRAPHY Marina Z. Deljanin Ilic, Stevan N. Ilic, Dragan S. Djordjevic, Dejan S. Petrovic, Ljubisa S. Nikolic, Bojan S. Ilic. Echo Lab, Institute of Cardiology, Niska Banja, University of Nis, Niska Banja, Yugoslavia. The aim of the study was a quantitative assessment of regional systolic and diastolic myocardial velocities (m.v.) changes in the presence of stress induced myocardial ischemia (m.i.) in hypertensive patients (pts) using pulsed wave Doppler myocardial imaging (PW DMI). We studied 67 pts (35 hypertensives, H group and 32 normotensives, N group) with known or suspected coronary artery disease. In all pts dobutamine stress echocardiography (DSE: from 5 up to 40 mcg/kg/min infused in 3 min stages, plus atropine 1 mg if needed) was performed. DSE identified ischemia by the occurrence of wall motion abnormalities (WMA) with stress - positive DSE. Apical views were used to assess m.v. on baseline and at the peak stress. The sample volume was placed in each of 11 adequately visualized segment in which the left ventricle was divided. In each segment peak m.v. of systolic (S), early (E) and late (A) diastolic waves and ratio E/A were calculated. During DSE 88 ischemic myocardial segments in 24 (68.5%) pts in H group were detected, while in 11 pts WMA were not appeared. In N group 63 ischemic segments in 18 (56.2%) pts were detected, while 14 pts had not ischemic response. In segments with DSE provoked WMA, m.v. in H and N group showed: decreased E by 21.7% and 18.3%, increased A by 16.2% and 11.2%, decreased ratio E/A by 32.3% and 26.4% and decreased S by 15.4% and 14.6% compared to baseline values. There were not significant differences in m.v. after DSE in non-ischemic segments between H and N group. Conclusion: Quantification of regional m.v. changes during conventional DSE showed that m.i. is associated with decreased E/A ratio, E and S m.v., and increased A m.v. Changes in diastolic m.v. in segments with DSE provoked m.i. are more pronounced in hypertensive than in normotensive pts. Key Words: Doppler Myocardial Imaging, Stress Echocardiography, Myocardial Ischemia
P-258 THE CLINICAL BENEFITS OF BISOPROLOL ON ANGINA AND QUALITY OF LIFE ARE SIMILAR IN BOTH HYPERTENSIVE AND NORMOTENSIVE PATIENTS Vivencio Barrios, Enrique Galve, Carlos Almeria, Luis M. Ruilope, BISOVID Investigators. Cardiology, Hospital Ramo´ n y Cajal, Madrid, Spain; Cardiology, Hospital Vall d’Hebron, Barcelona, Spain; Cardiology, Hospital Clı´nico, Madrid, Spain; Hypertension Unit, Hospital 12 de Octubre, Madrid. The BISOVID study was performed to assess the influence of the betablocker bisoprolol on the quality of life in patients with post-myocardial infarction stable angina. A total of 150 patients were selected (72% male, age:61⫾11) who were diagnosed of stable angina by a cardiologist after suffering from a myocardial infarction. They received bisoprolol 5-10 mg during 9 months, and were visited quarterly by the specialist. In order to measure health global aspects, the SF-36 quality of life test was performed in each visit. Fifty-nine percent of the patients suffer from hypertension, this condition being more frequent in women (74%) than in men (53%). The number of angina episodes was reduced from 0.9 per week at baseline to 0.2 at the study end. The number of patients experiencing at least one angina episode was also importantly reduced along the study 0895-7061/02/$22.00
AJH–April 2002–VOL. 15, NO. 4, PART 2
(91%, 33%, 14% and 9% at baseline, 3, 6 and 9 months respectively). No difference was observed between hypertensive and normotensive patients. The SF-36 scores were significantly increased (p⬍0.05) along the study, specially the physical and the emotional role, with wider improvements between baseline and the 3 months visits. These differences were also observed within the hypertensive and normotensive subgroups. The global increase in the average score was of 25 points (with a maximum of 51 for the physical role). At the end of the study, the scores were similar for both men and women, and significantly better than at baseline, despite at study onset the score in women was markedly lower. Permanent treatment withdraws was 5.3% and tolerability was high with 3.3% mild-moderate adverse events. The treatment with Bisoprolol in post-myocardial infarction patients with stable angina reduced the number of patients with episodes of angina, the average number of episodes in the global sample of patients, and induced a significant improvement in their quality of life. Treatment effects did not differ between hypertensive and normotensive patients. Key Words: Bisoprolol, Quality of Life, Angina
P-259 CHARACTERISTICS OF PATIENTS WITH CORONARY ARTERY DISEASE AND HYPERTENSION Sridhar R. Vennamaneni, Vinod R. Miryala, Dilip Bearelly. Internal Medicine, Cleveland Clinic Florida, Weston, FL, United States. Coronary artery disease (CAD) is the leading cause of death in the United States. Hypertension is a major risk factor for the development of CAD. We sought to determine the characteristics of patients with CAD and hypertension in patients referred to our hypertension clinic. We performed a retrospective review of the complete medical records of 223 hypertension patients treated at our hypertension Clinic. Charts were reviewed regarding demographic data and covariables obtained were age,sex,body mass index,diabetes,smoking and hypercholesterolemia. Factors associated with CAD were determined by logistic regression analysis. Of 223 patients, 57 patients had CAD (mean age 70.2 years, 56.1% men, 96.4% white). 91.2% patients were on anti-hypertensive treatment. 29.8% were controlled to systolic blood pressure (BP) goal, 87.7% to diastolic BP goal and only 17.5% were controlled to goal blood pressure of ⬍140 mm Hg systolic and ⬍90 mm diastolic. Most patients (38%) were treated with two drugs,24% with three and 14% with four antihypertensive drugs. Of these patients, 45.6% were on beta-blockers,40.3% on calcium channel blockers, 36.1% were on diuretics and 33.3% on ACE inhibitors. Patients with CAD had higher systolic BP and mean arterial pressure (p⬍0.05). Covariates associated with CAD included older age (OR for age 61 to 75 years,2.57, 95% CI 1.11 to 5.99; OR for age ⬎75 years,5.65, 95% CI 2.17 to 14.69, p⫽0.002), body mass index ⬎25 Kg/m2 (OR 2.37, 95% CI 1.15 to 4.86, p⫽0.02) and hypercholesterolemia (OR 2.83, 95% CI 1.31 to 6.11, p⫽0.008). An age of at least 60 years,increased body mass index and hypercholesterolemia are independent predictors for CAD in our sample of hypertension patients. Most cases of uncontrolled hypertension was due to isolated systolic hypertension and most of these patients may need more than 2 drugs to reach goal blood pressure. Key Words: Hypertension, Coronary Artery Disease Predictors, Blood Pressure Control © 2002 by the American Journal of Hypertension, Ltd. Published by Elsevier Science Inc.