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Coronary artery dimensions in primary and secondary left ventricular hypertrophy
P Kaufmann1, G Vassalli, S Lupi-Wagner
1Department of Internal Medicine, University Hospital, Zurich, Switzerland.
Insights
Coronary arteries enlarge with left ventricular hypertrophy, but this enlargement is insufficient relative to the increased heart muscle mass. The coronary artery growth stimulus depends on hypertrophy degree, not the underlying disease.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Coronary artery enlargement is a known phenomenon in left ventricular hypertrophy.
- This study investigates coronary artery dimensions in relation to left ventricular muscle mass.
Purpose of the Study:
- To assess coronary artery dimensions in primary and secondary left ventricular hypertrophy.
- To determine the relationship between coronary artery size and left ventricular muscle mass.
Main Methods:
- Quantitative coronary angiography was used to measure coronary artery cross-sectional area in 52 subjects (12 controls, 40 with hypertrophy).
- Left ventricular mass and muscle area were determined angiographically to assess hypertrophy.
Main Results:
- Both left and right coronary arteries showed increased cross-sectional area in left ventricular hypertrophy compared to controls (p < 0.05).
- A significant curvilinear relationship was observed between left coronary artery size and left ventricular muscle mass (r=0.76) or area (r=0.75).
- However, normalized coronary artery size was insufficient relative to left ventricular hypertrophy in both primary and secondary forms.
Conclusions:
- Coronary artery size increases with left ventricular mass in both primary and secondary hypertrophy.
- The enlargement of coronary arteries is independent of the cause of left ventricular hypertrophy.
- Coronary artery size is disproportionately small compared to the degree of left ventricular hypertrophy, suggesting the growth stimulus is dependent on hypertrophy severity.
Background:
Coronary artery enlargement has been previously described in left ventricular hypertrophy.
Objectives:
We sought to assess coronary artery dimensions and their relation to left ventricular muscle mass in primary and secondary hypertrophy.
Methods:
Cross-sectional area of the left and right coronary arteries was determined by quantitative coronary angiography in 52 patients: 12 control subjects and 40 patients (13 with hypertrophic cardiomyopathy, 12 with dilated cardiomyopathy and 15 with aortic valve disease). As a measure of left ventricular hypertrophy, angiographic left ventricular mass and equatorial cross-sectional muscle area were determined.
Results:
Cross-sectional area of both the left and right coronary arteries is increased in left ventricular hypertrophy (p < 0.05 vs. values in control subjects). There is a curvilinear relation between left coronary artery size and left ventricular muscle mass (r = 0.76) or cross-sectional muscle area (r = 0.75). However, normalization of coronary cross-sectional area for left ventricular muscle mass or muscle area shows insufficient enlargement of the coronary arteries in both primary and secondary hypertrophy.
Conclusions:
1) Coronary artery size increases as left ventricular mass increases in both primary and secondary hypertrophy. 2) The enlargement of left coronary cross-sectional area is independent of the cause of the increase in left ventricular mass. 3) The size of the coronary arteries is inappropriate with regard to left ventricular hypertrophy. Thus, the stimulus for growth of the coronary arteries is not influenced by the underlying disease but appears to depend on the degree of left ventricular hypertrophy.