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Detection of clinically significant coronary artery disease in hypertensive patients. Echocardiographic study.

Simultaneous echocardiograms and phonocardiograms were recorded and digitised in 29 normal control subjects and 88 unselected hypertensive patients. Left ventricular wall thickness and isovolumic relaxation time were measured. The time relations between valvular events and endocardial movement were examined. Dimension change during the period of isovolumic relaxation was measured. Left ventricular wall thickness ranged from normal values to massive hypertrophy in hypertensive patients. Isovolumic relaxation time was prolonged (85±25 ms) and related to increasing left ventricular wall thickness. When indices of the co-ordination of left ventricular wall movement were studied (time relation of aortic valve closure to minimum cavity dimension, dimension change during isovolumic relaxation), two separate groups of hypertensive patients were identified. Group 1 (60 patients) had normal time relations between valvular events and endocardial movement, with only small dimension changes during isovolumic relaxation, implying co-ordinate wall motion. Group 2 (28 patients) had abnormal time relations and large dimension changes during isovolumic relaxation implying incoordinate wall motion. All patients in group 1 had normal electrocardiograms. Fifty-eight were asymptomatic, while two patients with chest pain were shown to have non-significant coronary artery disease. In group 2, 25 of 28 patients had abnormal electrocardiograms. Ten patients had previously been shown to have significant coronary artery disease, while of the remaining 18, seven had angina and 11 were asymptomatic. In a 14-month follow-up seven of these 18 patients from group 2 (three with angina, four who were asymptomatic) had a major cardiac event (five myocardial infarctions, two sudden deaths) whereas no cardiac events occurred in the patients in group 1. The echocardiographic recognition of incoordinate left ventricular wall motion in a hypertensive population identifies a group of patients with a high incidence of clinically significant coronary artery disease.