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Left ventricular remodeling impairs coronary flow reserve in hypertensive patients
Stefan Schäfer1, Malte Kelm, Stefan Mingers
1Department of Internal Medicine, Division of Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany. stefan.schaefer@aventis.com
Insights
Concentric left ventricular remodeling, a change in hypertensive heart disease, independently predicts reduced coronary flow reserve. This impairment of coronary microcirculation may increase cardiovascular events in patients with normal coronary arteries.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Hypertension Research
Background:
- Arterial hypertension can lead to changes in left ventricular mass and geometry.
- Concentric left ventricular remodeling is an independent cardiovascular risk factor in hypertensive patients.
- The impact of concentric remodeling on coronary microcirculation remains unclear.
Purpose of the Study:
- To investigate how left ventricular geometry affects coronary flow reserve.
- Study focuses on hypertensive patients with normal coronary arteries.
Main Methods:
- Coronary flow reserve was measured in 49 hypertensive patients and 6 controls using dipyridamole and an argon gas-chromatographic method after excluding coronary artery disease.
- Hypertensive patients were categorized by echocardiography into normal geometry, eccentric hypertrophy, concentric remodeling, and concentric hypertrophy groups.
- Left ventricular mass and relative wall thickness were assessed based on echocardiographic measurements.
Main Results:
- All hypertensive groups showed reduced coronary flow reserve compared to controls.
- Coronary flow reserve was most reduced in concentric remodeling and concentric hypertrophy groups.
- Relative wall thickness, not left ventricular mass, was independently associated with coronary flow reserve.
Conclusions:
- Concentric left ventricular remodeling is an independent predictor of coronary flow reserve in hypertensive patients.
- Impaired coronary microcirculation in concentric remodeling may contribute to increased cardiovascular events.
- Findings highlight the significance of left ventricular geometry in hypertensive cardiovascular risk.
Background:
In arterial hypertension, changes in both left ventricular mass and geometry may occur. Concentric left ventricular remodeling (i.e. an increased wall thickness relative to end diastolic diameter) has been implicated as an independent cardiovascular risk factor in hypertensive patients. The influence of concentric remodeling on the coronary microcirculation is not known.
Objective:
To investigate the impact of left ventricular geometry on coronary flow reserve in patients with arterial hypertension and angiographically normal coronary arteries.
Methods:
Following exclusion of coronary artery disease by cardiac catheterization, coronary flow reserve (dipyridamole, 0.5 mg/kg body weight intravenously; argon gas-chromatographic method) was measured in 49 patients with arterial hypertension and in six age-matched controls. Hypertensive patients were grouped by echocardiographic findings according to left ventricular mass and relative left ventricular wall thickness (i.e. left ventricular posterior wall plus septal thickness divided by end diastolic diameter): seven patients had normal left ventricular mass and geometry, 19 had eccentric hypertrophy (i.e. normal relative wall thickness but increased mass), concentric remodeling (i.e. normal mass but increased relative wall thickness) was present in nine patients, and 14 patients had concentric hypertrophy.
Results:
There was a marked reduction in coronary flow reserve in all hypertensive groups as compared with control values (4.2 +/- 0.5). Within the hypertensive subgroups, the coronary flow reserve was differentially reduced in the following rank order: concentric remodeling (2.0 +/- 0.7) approximately concentric hypertrophy (2.3 +/- 0.8) < eccentric hypertrophy (2.9 +/- 0.6) mu normal geometry (2.7 +/- 0.4). Multi-factorial regression analysis showed that the relative wall thickness but not left ventricular mass was independently linked to the coronary flow reserve.
Conclusions:
Concentric left ventricular remodeling is an independent predictor of the coronary flow reserve in hypertensive patients with chest pain and normal coronary angiogram. The impairment of the coronary microcirculation may contribute to the excess cardiovascular event rate associated with hypertensive concentric left ventricular remodeling.