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Coronary flow reserve and myocardial diastolic dysfunction in arterial hypertension

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Abstract

The aim of this study was to assess the relation between coronary blood flow and left ventricular (LV) myocardial diastolic dysfunction in arterial hypertension. The study population included 30 hypertensive patients who were free of coronary artery disease and pharmacologic therapies. They underwent standard Doppler echocardiography and color tissue Doppler of the middle posterior septum at baseline and with high-dose dobutamine, and second-harmonic Doppler flow analysis of the distal left anterior descending coronary artery at baseline and after vasodilation by dipyridamole (0.56 mg/kg IV in 4’). Coronary flow reserve (CFR) was estimated as the ratio of hyperemic and baseline diastolic flow velocities. According to CFR, hypertensives were divided into 2 groups: 15 patients with normal CFR (≥2) and 15 patients with reduced CFR (<2). The 2 groups were comparable for sex, age, body mass index, baseline heart rate, and blood pressure. LV mass index was greater in hypertensives with reduced CFR (p <0.01). By color tissue Doppler, baseline and high-dose dobutamine septal systolic velocities did not differ between the 2 groups. The ratio between myocardial velocities in early diastole and at atrial contraction (Em/Am ratio) was lower in patients with reduced CFR, both at baseline (p <0.05) and with high-dose dobutamine (p <0.00001). After adjusting for age, body mass index, LV mass index, and both high-dose dobutamine diastolic blood rate and heart rate by a multiple linear regression analysis, Em/Am ratio at high-dose dobutamine was independently associated with CFR in the overall population (β 0.62, p <0.0005) (cumulative R2 0.38, p <0.0005). In conclusion, this study provides evidence of an independent association between CFR and myocardial diastolic function. In hypertensive patients without coronary artery stenosis, CFR alteration may be a determinant of myocardial diastolic dysfunction or diastolic impairment that should be taken into account as possibly contributing to coronary flow reduction.

Section snippets

Study population:

Between September 1998 and December 2000, 147 patients affected by newly diagnosed, never-treated arterial hypertension (World Health Organization/International Society of Hypertension grade 1 to 2) were screened at our outpatient clinic. Patients were defined as hypertensive if their diastolic BP was ≥90 mm Hg (mean of 3 different measurements on 3 different visits). Exclusion criteria were coronary artery disease (absence of angina pectoris and negative findings on the electrocardiogram at

Results

Characteristics of the population are listed in Table 1. High-dose dobutamine systolic BP was higher in patients with CFR <2. No patient complained of chest pain and no ST changes occurred using both stressors. Analyses of the Doppler echocardiographic data are listed in Table 2. Relative wall thickness and LV mass index were higher in patients with CFR <2. Doppler indexes were similar between the 2 groups.

The results of the dobutamine test and color tissue Doppler are listed in Table 3. Sm

Discussion

The present study used color tissue Doppler13, 14 and CFR determination10, 11, 12 to evaluate the possible association between LV myocardial diastolic function and CFR in arterial hypertension where changes in afterload and LV structure may influence both LV diastolic properties and coronary blood flow supply. Hypertensives were divided into 2 groups according to CFR level, with the cut-off point for normal CFR ≥2.11 The main findings of the study are: (1) hypertensives with abnormal CFR have a

Acknowledgements

The investigators are indebted to Liv Hatle, MD, for scientific comments, critical suggestions, and valuable review of the manuscript.

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