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Association of abnormal coronary microcirculatory function with impaired response of longitudinal left ventricular
Ignatios Ikonomidis1, Stavros Tzortzis, Ioannis Paraskevaidis
12nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari 12462, Greece. ignoik@otenet.gr
Insights
Hypertension impairs coronary microcirculation. Reduced coronary flow reserve (CFR) in untreated hypertensive patients is linked to abnormal left ventricular (LV) function responses during adenosine stress echocardiography, indicating impaired cardiac function.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Coronary microcirculation dysfunction is prevalent in hypertensive individuals.
- Assessing left ventricular (LV) function response to stress is crucial for understanding hypertensive heart disease.
- Coronary flow reserve (CFR) is a key indicator of microvascular health.
Purpose of the Study:
- To investigate the association between coronary flow reserve (CFR) and left ventricular (LV) function response.
- To evaluate LV function using tissue Doppler imaging (TDI) during adenosine stress echocardiography in never-treated hypertensive patients.
Main Methods:
- Adenosine stress echocardiography was performed on 90 hypertensive patients and 30 controls.
- Coronary flow reserve (CFR), mitral inflow velocities (E, A), and mitral annular velocities (S', E', A') were measured using TDI.
- Changes in TDI parameters during adenosine infusion were analyzed and correlated with CFR.
Main Results:
- Patients with CFR < 2.5 exhibited significantly blunted increases in S' and E', and reduced E'/A' ratio compared to controls and those with CFR ≥ 2.5.
- A reduced CFR (< 2.5) was independently associated with impaired LV longitudinal function response during stress.
- CFR < 2.5 predicted median changes in TDI markers with >70% sensitivity and specificity.
Conclusions:
- Impaired coronary microcirculation, indicated by reduced CFR, is associated with abnormal left ventricular longitudinal function during adenosine stress.
- Tissue Doppler imaging during stress echocardiography can identify functional deficits related to impaired CFR in hypertensive patients.
Aims:
Coronary microcirculation is disturbed in hypertensive patients. We investigated the association of coronary flow reserve (CFR) with the response of left ventricular (LV) function as assessed by tissue Doppler imaging (TDI) during adenosine stress echocardiography in never-treated hypertensive patients.
Methods And Results:
We studied 90 hypertensive patients and 30 control subjects, matched for age and sex, by adenosine stress echocardiography. We measured: (i) CFR, E and A Doppler, S', E', A' mitral annulus velocities with TDI, as well as the E'/A' ratio and the E/E' ratio before and during adenosine infusion (ii) the %changes of the measured indices between baseline and adenosine infusion. After adenosine infusion, there was an increase in S', E', and A' in all patients and controls (P < 0.05). Compared with controls and patients with CFR ≥ 2.5, patients with CFR <2.5 showed a smaller increase in S' (28.6 vs. 30.0 vs. 11.1%, F for interaction = 14.592) and E' (33.3 vs. 33.3 vs.1.5%, F = 28.927) as well as a decrease in E'/A' (9.2 vs. 6.4% vs. -20.0%, F = 5.128) and an increase in E/E' (-6.1 vs. -1.6 vs. 30.5%. F = 12.780) after adenosine infusion (P < 0.05 for all comparisons). CFR was independently related to %changes of TDI parameters (regression coefficient b = 0.576 for S'; b = 0.517 for E'; b = 0.473 for E'/A'; b = -0.520 for E/E', respectively, P < 0.001). By the receiver operating curve, a CFR <2.5 predicted the median changes of all measured TDI markers, with a sensitivity and specificity over 70% (AUC >75%, P < 0.05).
Conclusion:
An abnormal response of the LV longitudinal function during adenosine stress echocardiography is related to impaired CFR in untreated hypertensive patients.
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