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[Coronary morphometry in essential arterial hypertension]
A Dagianti1, S Rosanio, R Luongo
1Dipartimento di Scienze Cardiovascolari e Respiratorie, Università degli Studi La Sapienza, Roma.
Insights
Coronary artery tortuosity, a bending of arteries, is common in heart conditions like hypertension and hypertrophic cardiomyopathy. This study found tortuous arteries are linked to myocardial ischemia in essential hypertension patients.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Coronary artery tortuosity is an understudied vascular morphology.
- Its association with cardiac conditions and ischemic events requires further investigation.
Purpose of the Study:
- To determine the prevalence of coronary artery tortuosity in various cardiac diseases.
- To explore the pathophysiological significance of tortuosity, particularly its link to myocardial ischemia.
Main Methods:
- Reviewed 1530 coronaroventriculographies to identify coronary artery tortuosity.
- Analyzed echocardiograms for left ventricular hypertrophy.
- Compared hypertensive patients with and without tortuosity using various stress tests.
Main Results:
- Coronary tortuosity was prevalent in 64% of hypertensives, 58% of aortic stenosis patients, and 100% of hypertrophic cardiomyopathy patients.
- Tortuosity significantly associated with concentric left ventricular hypertrophy.
- Hypertensive patients with tortuous arteries showed a higher prevalence of myocardial ischemia (63% vs. 11%).
Conclusions:
- Coronary artery tortuosity is frequently observed in hypertensive and other cardiac disease patients.
- Tortuosity is linked to left ventricular hypertrophy and is an independent predictor of myocardial ischemia in essential hypertension.
Abstract:
To evaluate the prevalence and pathophysiological significance of I and II order coronary arteries with a tortuous course we reviewed 1530 coronaroventriculographies. Tortuosity was identified by the finding of 4 bendings at least, with an angle less than 60 degrees, present both in systole and in diastole. Morphologic alteration was found in 64% of hypertensives and in 13% only of non hypertensive coronaropathic patients; the prevalence was 58% in valvular aortic stenosis (being 16% in the remaining valvulopathies) and 100% in hypertrophic cardiomyopathy. No normal subject showed coronary tortuosity. A retrospective analysis of patients' echocardiograms pointed out a significant association between tortuosity and concentric left ventricular hypertrophy, expressed by mass/volume ratios clearly above the normal values (1 +/- 0.2): 1.6 +/- 0.17 in hypertensives, 2.1 +/- 0.2 in aortic stenoses and 2.6 +/- 0.2 in hypertrophic cardiomyopathy. Among hypertensive subjects, we selected a group with essential systemic hypertension and no coronary stenoses nor dysmetabolic diseases: this group was divided into 2 subgroups on the basis of presence or absence of coronary tortuosity. A comparison of these subgroups for age, echocardiographic parameters (left ventricular mass index, mass, mass/volume ratio, end systolic stress) and hemodynamic data (end diastolic left ventricular pressure, gradient: mean aortic pressure--end diastolic left ventricular pressure) showed no significant difference between patients with or without tortuosity. Moreover those patients were evaluated by ergometric test, echo stress, cold pressor test and dipyridamole stress test: a significantly higher prevalence of myocardial ischemia was found in the subgroup with tortuous vessels (63% versus 11%, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)