The antihypertensive treatment effect on left ventricular diastolic function is reflected in exercise electrocardiogram

Background/PurposeExercise electrocardiographic hump sign is associated with uncontrolled arterial hypertension (AH), left ventricular (LV) diastolic dysfunction, and false-positive exercise testing (ET). The aim of this prospective study was to evaluate the antihypertensive treatment effect on hump and on pseudoischemic ST-segment depression and potential correlations to LV diastolic function and mass changes.MethodsThe study comprised 59 non–coronary artery disease patients (45.9 years; 67.8% men) with never-treated arterial hypertension (143.2/95.1 mm Hg). Treadmill ET and echocardiography were performed at baseline and 6 months after pharmaceutical blood pressure normalization. Prevalence of hump and ST depression, transmitral (E/A) and tissue Doppler imaging (E′/A′) early/late velocities ratios, E/E′ ratio, and LV mass index (LVMI) were all defined.ResultsPrevalence of hump was reduced from 69.5% to 23.7% and false-positive ETs from 35.6% to 18.6% (P < .05). Significant improvement (P < .05) was found in E′/A′ ratio (0.68 vs 0.84), E/E′ ratio (9.3 vs 7.9), and LVMI (109.2 vs 99.8 g/m2). Changes in hump were related to ST-depression changes (r = 0.632, P < .001) and to LV diastolic indices changes; patients with hump only at first ET (54.2%) improved E/A and E′/A′ ratios, whereas patients with hump only at second ET (8.5%) worsened diastolic indices with similar changes in blood pressure and LVMI.ConclusionsAntihypertensive treatment reduces the prevalence of hump and exercise ischemic-appearing ST depression probably through LV diastolic function improvement.