The evaluation of atrial conduction properties and echocardiographic parameters in normotensive patients with exaggerated blood pressure response during exercise

Purpose: The aim of this study is to evaluate the atrial conduction properties in normotensive patients with exaggerated blood pressure response (EBPR) during treadmill stress test. Material and methods: Study is a single-center, observational study. The study included patients who underwent treadmill test with suspicion of coronary artery disease at the Cardiology Clinic of Dicle University Hospitals. The hypertensive response in treadmill stress test; in accordance with Framingham criteria, systolic blood pressure at peak exercise is defined as ≥210 mmHg for men and ≥190 mmHg for women. The study included 25 patients with hypertensive response to effort and 28 patients patients with normal blood pressure response as a control group with a similar age and gender. The blood pressure of the patients was evaluated with holter tension arterial and white coat hypertension was excluded. In echocardiographic study left ventricular systolic functions, diastolic functions and tissue Doppler examinated according to the American Society of Echocardiography guidelines. Between the groups compared to the atrial conduction properties measured by tissue Doppler method, holter tension arterial measurements, conventional echocardiographic fındings Results: There was no statistically significant different between the patients groups in terms of tension holter, conventional echocardiography and stress test results. In the study of electromechanical conduction by tissue Doppler examination in each patient group, and lateral PA (time interval from the onset of the P to the beginning of the A wave) was 74.0±6.3 ms in the EBPR group and 68.8±5.7 ms in the control group and there was a statistically significant difference (p=0.003). The mean left atrial electromechanic delay was 24.9±7.2 ms in the EBPR group and 19.3±7.0 ms in the control group and difference was statistically significant (p= 0.007). Interatrial electromechanical delay (EMD) was 37.1 ±8.5 ms in the EBPR group and 30.7±6.7 ms in the control group and there was a statistically significant difference (p=0.004). Conclusions: Left atrial PA, interatrial electromechanical delay and left atrial electromechanical delay was significantly longer in group with an exaggerated blood pressure response to the exercise stress test than the control group. Cardiovascular events in patients with hypertensive response to stress test and non-invasive early detection of risk of arial fibrillation can prevent unwanted cardiovascular events. However, larger and more randomized controlled trials are needed to confirm these findings. Keywords: exercise stres test, exaggerated blood pressure response, electromechanical delay