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Updated: Jul 3, 2026
Coronary Angiography During Ex-Situ Heart Perfusion in a Porcine Model
Published on: July 12, 2024
Myocardial perfusion in hypertensive patients with normal coronary angiograms
Kalina Kawecka-Jaszcz1, Danuta Czarnecka, Agnieszka Olszanecka
1I Department of Cardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland.
Insights
Hypertension impairs myocardial perfusion reserve, even without left ventricular hypertrophy, potentially causing angina in patients with chest pain and normal coronary angiography. This study used cardiovascular magnetic resonance to assess perfusion.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Hypertension Research
Background:
- Hypertension can lead to pressure-induced left ventricular hypertrophy, impairing coronary vasodilating capacity and causing myocardial ischemia and angina.
- Investigating myocardial perfusion is crucial for understanding angina in hypertensive patients with normal coronary angiography.
Purpose of the Study:
- To investigate myocardial perfusion using cardiovascular magnetic resonance (CMR) in patients with arterial hypertension and chest pain but normal coronary angiography.
- To estimate the influence of left ventricular hypertrophy (LVH) on myocardial perfusion parameters.
Main Methods:
- 102 hypertensive patients and 12 healthy volunteers underwent CMR.
- Myocardial first-pass perfusion CMR was performed at rest and during adenosine infusion.
- Semiquantitative analysis derived myocardial perfusion index and reserve index; patients were grouped by LVH presence.
Main Results:
- Hypertensive patients showed significantly higher baseline and stress myocardial perfusion indices compared to controls, irrespective of LVH.
- Myocardial perfusion reserve index was reduced in the mid and apical left ventricle of hypertensive patients.
- No significant correlation was found between myocardial perfusion reserve index and left ventricular mass or hypertrophy.
Conclusions:
- Patients with mild/moderate hypertension, chest pain, and normal coronary angiography exhibit regional myocardial perfusion reserve impairment.
- This impairment is independent of left ventricular hypertrophy and may explain angina in these patients.
Background:
Pressure-induced left ventricular hypertrophy is one of the mechanisms responsible for an impaired coronary vasodilating capacity leading to myocardial ischemia and angina. The aim of the study was to investigate myocardial perfusion using cardiovascular magnetic resonance in patients with arterial hypertension and a history of chest pain and normal coronary angiography, and to estimate the influence of left ventricular hypertrophy on the parameters of myocardial perfusion.
Methods:
The study included 102 patients (mean age 55.4 +/- 7.7 years) with well controlled hypertension and 12 healthy volunteers. In 96 patients, myocardial first-pass perfusion cardiovascular magnetic resonance both at rest and during an infusion of adenosine 140 microg/kg/min was performed. Semiquantitative perfusion analysis was performed by using the upslope of myocardial signal enhancement to derive the myocardial perfusion index and the myocardial perfusion reserve index. The study group was divided according to the presence of left ventricular hypertrophy in the cardiovascular magnetic resonance examination: group with left ventricular hypertrophy (n = 40) and without left ventricular hypertrophy (n = 56).
Results:
Independent of the presence of left ventricular hypertrophy, there were significant differences in baseline myocardial perfusion index between hypertensive patients and controls (0.13 +/- 0.07 vs. 0.04 +/- 0.01; P < 0.001), and in stress myocardial perfusion index (hypertensive patients 0.21 +/- 0.10 vs. controls 0.09 +/- 0.03; P < 0.001). In hypertensive patients, the myocardial perfusion reserve index was reduced in the mid and apical portions of the left ventricle (1.71 +/- 1.1 vs. 2.52 +/- 0.83; P < 0.02). There was no significant correlation of myocardial perfusion reserve index with left ventricular mass or hypertrophy.
Conclusion:
In patients with mild or moderate hypertension and a history of chest pain with normal coronary angiography, there is regional myocardial perfusion reserve impairment that is independent of the presence of left ventricular hypertrophy and may be a reason for angina.
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