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[Echocardiographic evaluation of coronary flow reserve in patients with essential hypertension]
G Arcidiacono1, L Privitelli, A Laurenti
1Divisione Clinicizzata di Medicina Interna e Specialità Internistiche, Università degli Studi di Catania, Azienda Ospedaliera Garibaldi, Catania, Italy.
Insights
Essential arterial hypertension (EAH) causes early coronary alterations, reducing coronary blood flow reserve even before left ventricular hypertrophy (LVH). This increases coronary event risk in hypertensive patients.
Area of Science:
- Cardiology
- Vascular Biology
- Hypertension Research
Background:
- Essential arterial hypertension (EAH) can lead to left ventricular hypertrophy (LVH).
- LVH causes structural and functional changes in coronary vessels, potentially impairing coronary blood flow reserve.
- Early detection of coronary alterations in hypertension is crucial for risk stratification.
Purpose of the Study:
- To evaluate coronary blood flow and vasodilatation capacity in hypertensive patients with and without LVH.
- To assess coronary blood flow reserve under basal conditions and during dipyridamole infusion.
- To compare these parameters between hypertensive subjects and normotensive controls.
Main Methods:
- Eighty patients (50 hypertensive with/without LVH, 30 normotensive) were selected using ECG, echo color Doppler, and transesophageal echocardiography.
- Transesophageal echocardiography was performed before and during intravenous dipyridamole infusion.
- The study observed patients for 18 months with no dropouts.
Main Results:
- Coronary resistances decreased during dipyridamole infusion in hypertensive patients but remained higher than in controls.
- Hypertensive subjects showed reduced coronary vasodilatation capability, possibly due to increased basal tone or reduced vessel compliance.
- Coronary blood flow reserve was significantly reduced in all hypertensive patients, including those without LVH.
Conclusions:
- Essential arterial hypertension is a primary cause of early coronary anatomical and functional alterations.
- These alterations increase the risk of coronary events in hypertensive individuals, even before the development of LVH.
- Hypertension itself, independent of LVH, impacts coronary physiology and reserve.
Background:
In patients with essential arterial hypertension (EAH) the left heart ventricular hypertrophy (LVH) causes structural and functional alterations of the coronary vessels that can alter the coronary blood flow reserve. The aim of this study is to evaluate in hypertensive patients with or without LVH versus normotensive subjects, the blood flow and the coronary vasodilatation capability and the coronary blood flow reserve in basal conditions and during dipiridamole i.v. infusion.
Methods:
Eighty patients have been selected by ECG, echo color Doppler, transesophageal echocardiography: 50 were hypertensive patients with and without LVH, from mild to moderate to severe and 30 were normotensive subjects. The enrolled patients underwent a first transesophageal echocardiography, before and during infusion of 0.86 mg/kg of dipiridamole in growing doses, 0.56 in four minutes followed after three minutes by 0.30 mg/kg. The observation lasted 18 months, and no patients left the study.
Results:
The coronary resistances in hypertensive patients were significintally reduced during dipiridamole infusion, maintaining their level higher compared to the normal controls. The reduced coronary vasodilatation capability in hypertensive subjects could be due to an increase of the basal vessel tone and/or a reduced compliance of the coronary resistances. The coronary blood flow reserve is significantly reduced in all hypertensive studied, included those without LVH. It is suggested that this is secondary to increase of the coronary blood flow and tone.
Conclusions:
In conclusion essential arterial hypertension is the cause of early anatomical and functional coronary alterations leading hypertensive subjects to risk for coronary events before LVH.