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Clinical implications of assessing coronary flow velocity reserve and plasma endothelin-1 in hypertensive patients

Hideki Fujii1, Shin Takiuchi, Kei Kamide

  • 1Division of Hypertension and Nephrology, National Cardiovascular Center, Suita, Japan. hideki-f@tg7.so-net.ne.jp

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|March 25, 2006
PubMed

Insights

Hypertensive patients with chest pain but no coronary artery disease show higher endothelin-1 (ET-1) levels and lower coronary flow velocity reserve (CFVR), suggesting endothelial dysfunction contributes to their symptoms.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Hypertensive patients with angina-like chest pain and normal coronary arteriograms often exhibit reduced coronary flow velocity reserve (CFVR).
  • Elevated plasma endothelin-1 (ET-1) levels are linked to microvascular angina, a condition characterized by chest pain without obstructive coronary artery disease (CAD).

Purpose of the Study:

  • To investigate plasma ET-1 levels and CFVR in hypertensive patients experiencing chest pain but lacking obstructive CAD.
  • To determine the relationship between ET-1, CFVR, and chest pain symptoms in this patient cohort.

Main Methods:

  • Sixty-six patients without CAD (confirmed by stress test or coronary angiogram) were assessed.
  • Plasma ET-1 levels and CFVR, measured via adenosine-triphosphate stress transthoracic Doppler echocardiography, were compared between patients with (n=35) and without (n=31) a history of angina-like chest pain.

Main Results:

  • Symptomatic patients had significantly higher mean ET-1 levels (3.85 +/- 1.24 pg/ml) and lower mean CFVR (2.26 +/- 0.48) compared to asymptomatic patients (ET-1: 2.98 +/- 1.27 pg/ml, CFVR: 2.77 +/- 0.11).
  • Plasma ET-1 levels and CFVR showed a significant negative correlation (r = -0.265, p = 0.033).
  • Multiple regression analysis identified age and plasma ET-1 concentration as independent predictors of CFVR.

Conclusions:

  • Attenuated CFVR in symptomatic hypertensive patients without CAD is associated with endothelial dysfunction, reflected by elevated plasma ET-1 levels.
  • The interplay between ET-1 and CFVR may contribute to the development of chest pain in hypertensive individuals without obstructive coronary artery disease.

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