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Attenuated coronary flow reserve and vascular remodeling in patients with hypertension and left ventricular
S Hamasaki1, J Al Suwaidi, S T Higano
1Center for Coronary Physiology and Imaging, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Insights
Hypertension with left ventricular hypertrophy (LVH) is linked to coronary vascular remodeling and reduced coronary flow reserve. This impacts endothelial function, highlighting the need for further cardiovascular research.
Area of Science:
- Cardiology
- Vascular Biology
- Hypertension Research
Background:
- The relationship between coronary vascular remodeling, endothelial function, and hypertension with left ventricular hypertrophy (LVH) remains incompletely understood.
- Investigating coronary flow reserve in patients with hypertension and LVH is crucial for understanding cardiovascular disease progression.
Purpose of the Study:
- To determine the association between hypertension and left ventricular hypertrophy (LVH) with coronary vascular remodeling.
- To evaluate the impact of hypertension and LVH on endothelial function and coronary flow reserve.
Main Methods:
- Intravascular ultrasound was used to assess coronary artery dimensions in 111 patients.
- Patients were categorized into three groups: hypertensive with LVH, hypertensive without LVH, and normotensive.
- Vascular reactivity was assessed using intracoronary infusions of adenosine and acetylcholine.
Main Results:
- Patients with LVH exhibited significantly greater coronary vessel area compared to hypertensive patients without LVH.
- Coronary blood flow was significantly higher at baseline in patients with LVH.
- Endothelial and nonendothelial responses to acetylcholine and adenosine were significantly impaired in patients with LVH.
Conclusions:
- Hypertension combined with left ventricular hypertrophy is associated with significant coronary vascular remodeling.
- Patients with hypertension and LVH demonstrate attenuated endothelial and nonendothelial coronary flow reserve.
- These findings underscore the detrimental effects of hypertension and LVH on coronary vascular health.
Objectives:
The purpose of this study was to evaluate the association between hypertension and left ventricular hypertrophy (LVH) with both coronary vascular remodeling and endothelial function.
Background:
The association between endothelial and nonendothelial coronary flow reserve with vascular remodeling in patients with hypertension and LVH is still unclear.
Methods:
One hundred and eleven patients with normal or mildly diseased coronary arteries at angiography underwent intravascular ultrasound examination of the left anterior descending coronary artery. Patients were divided into three groups: group 1: n = 13, hypertensive patients with LVH; group 2: n = 30, hypertensive patients without LVH; group 3: n = 68, normotensive patients. Vessel and lumen area and atherosclerotic plaque area were evaluated. Vascular reactivity was examined using intracoronary adenosine and acetylcholine.
Results:
Vessel area in group 1 (with LVH) was significantly (p < 0.01) greater than that in group 2 (without LVH), whereas, vessel area in both groups 1 and 3 was similar (12.8 +/- 0.8 mm2, 10.7 +/- 0.4 mm2 and 11.5 +/- 0.3 mm2). Coronary blood flow at baseline for patients in group 1 (with LVH) was significantly greater than it was for patients in groups 2 and 3 (81.1 +/- 9.9 ml/min, 56.5 +/- 6.2 ml/min and 48.1 +/- 3.2 ml/min, both p < 0.05). In comparison with groups 2 and 3, the response to both acetylcholine and adenosine was significantly impaired in patients with LVH.
Conclusions:
The current study demonstrates that hypertension with LVH is associated with both coronary vascular remodeling and attenuated endothelial and nonendothelial coronary flow reserve.
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