OBJECTIVE: Left ventricular hypertrophy (LVH) often accompanies by the development of silent myocardial ischaemia. Myocardial ischaemia is an important factor of ventricular arrhythmias and sudden death.

DESIGN AND METHODS: We studied 70 patients (pts) with arterial hypertension, 38 pts out of them with essential hypertension (EH) and
32- with secondary arterial hypertension (SAH) of renoparenchymal genesis without symptoms of coronary heart disease (43 males and 27 females, mean age 52.1 ±7.3 years). In all pts dobutamine stress-echocardiography (SE) was performed (from 5 mcg/kg/min to 40 mcg/kg/min infused in
3 min stages). All pts, who did not achieve target heart rate in maximal dose of dobutamine, atropine (up to 1 mg) was added. At rest, during and after the SE, ECG and 2D ECHO were simultaneously monitored. Myocardial ischaemia was determined by new transient wall motion abnormality (WMA) on 2D ECHO and/or WMA and >0.1 mV of ST-segment depression relative to the resting ECG. Wall motion abnormality index (WMAI) was calculated.

RESULTS: LVMI was higher in SAH pts compared with EH pts (168.3 ±10.3 versus 154.3 ±9.2 g/m² , p<0.05). Ischaemic response was registered in 13 (34.2%) EH pts and 18 (56.2%) SAH pts during the SE. In these pts LVMI was higher than in pts without ischaemic response. WMAI was significantly higher in SAH pts compared with WMAI in EH pts (1.73 ±0.39 versus 1.40 ±0.42, p <0.05). Ventricular arrhythmias were appeared more often in SAH pts than in EH pts (13 versus 9).

CONCLUSION: The SE permits to reveal the group of pts with high risk of cardiovascular complications. More pronounced signs of myocardial ischaemic injures in SAH than in EH relate to higher LVMI in these pts.

DNC

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