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Published on: April 13, 2015
Impact of myocardial diastolic dysfunction on coronary flow reserve in hypertensive patients with left ventricular
M Galderisi1, S Cicala, L De Simone
1Department of Clinical and Experimental Medicine, Federico II University of Naples, Italy. mgalderi@unina.it
Insights
In hypertensive patients, impaired diastolic function is linked to reduced coronary flow reserve (CFR), even without left ventricular hypertrophy (LVH). This suggests diastolic dysfunction may impact microvascular vasodilation or indicate silent ischemia.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Left ventricular hypertrophy (LVH) is a common complication of hypertension.
- Diastolic dysfunction and coronary flow reserve (CFR) are important indicators of cardiac health.
Purpose of the Study:
- To investigate the association between left ventricular myocardial diastolic dysfunction and CFR in hypertensive patients.
- To determine if left ventricular hypertrophy (LVH) influences this relationship.
- To explore the potential role of diastolic dysfunction in impaired coronary microvasculature function.
Main Methods:
- Twenty-eight untreated hypertensive patients without coronary artery disease were studied.
- Doppler echocardiography, including tissue Doppler imaging and harmonic Doppler, was used.
- Coronary flow reserve (CFR) was assessed using diastolic velocities during dobutamine and dipyridamole stress.
- Patients were categorized based on the presence or absence of LVH.
Main Results:
- The myocardial early and atrial peak velocity ratio (Em/Am) was significantly lower in hypertensive patients with LVH.
- Coronary flow reserve (CFR) was also reduced in patients with LVH.
- The Em/Am ratio, particularly during high-dose dobutamine stress, independently predicted CFR in the overall hypertensive population.
Conclusions:
- In arterial hypertension, myocardial diastolic properties are associated with CFR, irrespective of LVH.
- Left ventricular myocardial diastolic dysfunction may impair coronary microvessel vasodilation or serve as a marker for silent microvascular ischemia in hypertensive patients without coronary stenosis.
Background:
The aim of the study was to assess the possible association, in hypertensive patients, between left ventricular myocardial diastolic dysfunction and coronary flow reserve (CFR) in relation to the presence of left ventricular hypertrophy (LVH).
Methods:
Twenty-eight untreated hypertensives (22 males, 6 females, mean age 53.1 years), free of coronary artery disease, were enrolled in the study. Standard Doppler echocardiography, color Doppler tissue imaging of the posterior septum during dobutamine stress and second harmonic Doppler of the distal left anterior descending coronary vessel, at baseline and after maximal hyperemia induced by dipyridamole, were performed. CFR was estimated as the ratio between hyperemic and baseline diastolic velocities. Hypertensives were divided into two groups according to the left ventricular mass index: 15 without LVH (left ventricular mass index < 51 g/m2.7) and 13 with LVH (left ventricular mass index > 51 g/m2.7). The two groups were comparable for sex prevalence, age, body mass index, baseline heart rate and blood pressure.
Results:
Color Doppler tissue imaging did not show any significant difference of both the baseline and high-dobutamine septal systolic peak velocities between the two groups. The ratio between myocardial early and atrial peak velocities (Em/Am ratio) was lower in patients with LVH, either at baseline (p < 0.01) or at high-dose dobutamine (p < 0.0001). Also, CFR was lower in the presence of LVH (p < 0.01). After adjusting for age, body mass index, left ventricular mass index, diastolic blood pressure and high-dose dobutamine heart rate by a multiple linear regression analysis, the high-dose dobutamine Em/Am ratio was an independent contributor of CFR in the overall hypertensive population (beta = 0.65, p < 0.0001) (cumulative r2 = 0.38, p < 0.0001).
Conclusions:
The combined use of second harmonic Doppler and color Doppler tissue imaging identifies, in arterial hypertension, an association between myocardial diastolic properties and CFR, independent of the presence of LVH. In hypertensive patients free of coronary artery stenosis, left ventricular myocardial diastolic dysfunction may be a determinant in the impairment of the coronary microvessel vasodilation capacity or a marker of silent ischemia involving the microvascular circulation.
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