Dobutamine stress echocardiography in detection of symptomatic, silent and supersilent myocardial ischemia in hypertensive patients

Abstract

The aim of the study was to evaluate the role of dobutamine stress echocardiography (DSE) in detection of symptomatic, silent and supersilent myocardial ischemia in patients (pts) with hypertensive heart disease. In the study group of 67 hypertensive pts (41 male and 26 female; mean age 56.5 +/- 9.1 years) with echo documented left ventricular hypertrophy, and known or suspected coronary artery disease, DSE (from 5 up to 40 mcg/kg/min infused in 3 min stages, plus atropine 1 mg if needed) was performed. At rest, during and after DSE, ECG and 2D echo were simultaneously monitored. Myocardial ischemia was determined by new transient wall motion abnormality (WMA) on 2D echo and/or WMA and >0.1mV of ST-segment depression relative to the resting ECG. Before and after DSE wall motion score index (WMSI) was calculated. During DSE 38 (56.7%) pts had ischemic response. Out of them 15 (39.5%) had all markers of ischemia (WMA + ST-segment depression + chest pain) and two (5.3%) pts had WMA + chest pain (pts with symptomatic myocardial ischemia); 12 (31.6%) pts had WMA + ST-segment depression (silent myocardial ischemia) and 9 (23.6%) pts had only WMA (supersilent myocardial ischemia). Value of WMSI after DSE was significantly smaller in pts with silent and supersilent myocardial ischemia than in pts with symptomatic myocardial ischemia (1.31 +/- 0.24 vs 1.48 +/- 0.20; P<0.05). DSE is accurate test for detecting presence of stress induced myocardial ischemia in pts with hypertensive heart disease; it's value in detection of silent myocardial ischemia is higher than dobutamine electrocardiogram. DSE offers detection of supersilent myocardial ischemia which is not allowed by stress electrocardiogram.