Coronary flow reserve in hypertensive patients with appropriate or inappropriate left ventricular mass

Galderisi, Maurizio; Simone, Giovanni de; Cicala, Silvana; Simone, Luigi De; D’Errico, Arcangelo; Caso, Pio; Divitiis, Oreste de

doi:10.1097/00004872-200311000-00029

Cited by 54 publications

(37 citation statements)

References 29 publications

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“…7,22 One speculation is that the excessive growth of LVM is associated with changes in myocardial structure, with a disproportionate increase in extracellular matrix and myocardial fibrosis. 25 Myocardial fibrosis could determine abnormalities in coronary microcirculation blood supply, contributing to myocardial ischemia, 26 diastolic filling, relaxation impairment, and favoring heart failure and/or supraventricular arrhythmias. In our study we could observe that, in patients with regression of inappropriate LVM, a significant increase in stroke volume was observed, whereas the opposite occurred in patients with inappropriate LVM development, possibly influencing the incidence of heart failure; 13 heart failure events occurred in patients with persistence or development of inappropriate LVM, and only 1 occurred in patients with persistently appropriate LVM.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate Left Ventricular Mass Changes During Treatment Adversely Affects Cardiovascular Prognosis in Hypertensive Patients

et al. 2007

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Abstract-Inappropriate left ventricular mass (LVM; ie, the value of LVM exceeding individual needs to compensate hemodynamic load) predicts the risk of cardiovascular (CV) events, independent of risk factors, either in the presence or in the absence of traditionally defined LV hypertrophy. The relation between changes in appropriateness of LVM during antihypertensive treatment and subsequent prognosis was evaluated in 436 prospectively identified uncomplicated hypertensive subjects, with a baseline and follow-up standard clinical evaluation, laboratory examinations, and echocardiogram (last examination: 6Ϯ3 years apart), followed for additional 4.5Ϯ2.5 years. is initially a useful compensatory process to abnormal loading conditions, but it is also the first step toward the development of overt clinical disease. [1][2][3][4] In the attempt to discriminate between normal (compensatory) and abnormal (noncompensatory) increase in LV mass (LVM), it has been proposed recently to evaluate LVM increase in hypertensive patients taking into account gender and cardiac loading conditions rather than some measure of body size. 5 Patients with inappropriate LVM, exceeding the amount needed to adapt to stroke work for a given gender and body size, tend to cluster with metabolic risk factors. 6 More interestingly, prevalence of low systolic myocardial function, as well as of abnormal relaxation, is greater in hypertensive patients with inappropriate LVM, suggesting that this condition may represent an accelerated phase of transition from compensatory LVH toward heart failure. 7,8 Two studies have demonstrated that the presence of inappropriate LVM implies a greater risk of cardiovascular (CV) events, either in the presence or in the absence of traditionally defined LVH. 9,10 The reduction of echocardiographically determined LVM, along with the normalization of LV geometry, during antihypertensive treatment, has been associated with a reduction in risk for subsequent CV disease. 11,12 No data are presently available on changes in appropriateness of LVM during antihypertensive treatment in hypertensive patients. Therefore, we aimed to investigate the relation between changes in appropriateness of LVM during antihypertensive treatment and subsequent prognosis for CV events in a large group of prospectively identified essential hypertensive patients with and without LVH undergoing usual medical treatment. Methods SubjectsWe identified uncomplicated hypertensive subjects, selected from an ongoing prospective registry of morbidity and mortality, including patients referred for high blood pressure (BP) diagnostic workup. At entry, all of the patients were never treated (nϭ247) or had withdrawn for Ն4 weeks before antihypertensive treatment (nϭ189); they had clinic systolic BP Ն140 and/or diastolic BP Ն90 mm Hg on

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Section: Discussionmentioning

confidence: 99%

Inappropriate Left Ventricular Mass Changes During Treatment Adversely Affects Cardiovascular Prognosis in Hypertensive Patients

et al. 2007

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“…More recently, increased coronary resistance and impaired CFR has been reported in hypertensive subjects with LVH vs those without, using trans-oesophageal echocardiography and adenosine infusion. 42 Reduced coronary flow velocity reserve has been reported in hypertensives with vs those without echocardiographic LVH using trans-thoracic echocardiography, 43 a technique that allows evaluation of intracoronary peak velocities but not coronary dimension change and therefore cannot be use to extrapolate changes in myocardial blood flow. Although evidences have been accumulated on the fact that CFR is impaired in many types of pathologic hypertrophy, the anatomic or biochemical basis for these observations remained elusive.…”

Section: Discussionmentioning

confidence: 99%

Relations of left ventricular mass and systolic function to endothelial function and coronary flow reserve in healthy, new discovered hypertensive subjects

et al. 2005

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Left ventricular hypertrophy (LVH) is prognostically relevant, associated with major cardiovascular risk factors and with atherosclerosis. However, whether LVH is independently associated with impaired coronary flow reserve (CFR) and with endothelial dysfunction is disputed. We assessed the relationship of LV mass and systolic function to CFR and endothelial function in new discovered never treated subjects with essential arterial hypertension, but without coronary artery disease or microalbuminuria. LVH, ejection fraction (EF) and stress-corrected midwall shortening (MWS, a measure of myocardial contractility) were assessed by echocardiography. CFR was assessed by single-photon emission computed tomography and dipyridamole infusion. Endothelial function was evaluated by assessing 1-min postischaemic flow-mediated dilatation of the brachial artery (FMD); nitroglycerine-mediated dilatation (NMD) of the same brachial artery was used as measure of nonendothelium-dependent vasodilatation. In approximately 1 year, we enrolled 21 subjects who met stringent inclusion criteria (47710 years old, 26.672.8 kg/m 2 , 78% men). Five patients showed LVH. Multivariate analyses showed a significant negative correlation of LV mass index with FMD (b ¼ À0.61, Po0.05) but not with NMD, neither with CFR. Stress-corrected MWS showed independent correlation with CFR (b ¼ 0.51, Po0.05). Thus, in clinically healthy, new discovered hypertensive subjects, never treated and mostly in the early stage of arterial hypertension, LVH can be associated with endothelial dysfunction while maximal dipyridamoledependent CFR may be preserved; nevertheless, a cardiac phenotype presenting with tendency to impaired myocardial contractility, assessed by stress-corrected MWS, showed association with lower CFR in the early stage of arterial hypertension.

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“…Thus, in this report we used the peak coronary velocity in early diastole assuming that the temporal peak velocity is proportional to the temporal mean velocity taken over the cardiac cycle. This assumption has been validated in man (Saraste et al, 2001), and the use of peak diastolic velocity in place of average diastolic velocity in the estimation of coronary reserve is becoming more common and accepted in clinical studies because maximum velocity is more robust, easier to measure, and less affected by noise, cardiac motion, and flow in neighboring vessels Galderisi et al, 2003;Rigo, 2005;Santagata et al, 2005;Saraste et al, 2001). In the studies reported here we did not see significant changes between baseline and hyperemia in the waveform of coronary velocity or in the ratio of systolic to diastolic velocity.…”

Section: Factors Affecting Baseline and Hyperemic Velocitiesmentioning

confidence: 97%

Effects of Isoflurane on Coronary Blood Flow Velocity in Young, Old and ApoE−/− Mice Measured by Doppler Ultrasound

Hartley

Reddy

Madala

et al. 2007

Ultrasound in Medicine & Biology

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The commonly used anesthetic agent, isoflurane (ISO), is a potent coronary vasodilator which could potentially be used in the assessment of coronary reserve, but its effects on coronary blood flow in mice are unknown. Coronary reserve is reduced by age, coronary artery disease, and other cardiac pathologies in man, and some of these conditions can now be modeled in mice. Accordingly, we used Doppler ultrasound to measure coronary flow velocity in mice anesthetized at low (1%) and at high (2.5%) levels of ISO to generate baseline (B) and elevated hyperemic (H) and Y and between A and O were significant (P < 0.01), while the differences in hyperemic velocities were not (P > 0.05). H/B was higher in old mice due to decreased baseline flow rather than increased hyperemic flow velocity. In contrast ApoE −/− mice have increased baseline and hyperemic velocities perhaps due to coronary lesions. The differences in baseline velocities between young and old mice could be due to age-related changes in basal metabolism or to differential sensitivity to isoflurane. We conclude that Doppler ultrasound combined with coronary vasodilation via isoflurane could provide a convenient and noninvasive method to estimate coronary reserve in mice, but also that care must be taken when assessing coronary flow in mice under isoflurane anesthesia because of its potent coronary vasodilator properties.

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Coronary flow reserve in hypertensive patients with appropriate or inappropriate left ventricular mass

Abstract: In hypertensive patients free of coronary artery disease, the degree of reduction in CFR is associated with the excess of LVM beyond the values compensatory for individual haemodynamic load. This relation is also independent of the presence of LV hypertrophy.

Cited by 54 publications

References 29 publications

Inappropriate Left Ventricular Mass Changes During Treatment Adversely Affects Cardiovascular Prognosis in Hypertensive Patients

Inappropriate Left Ventricular Mass Changes During Treatment Adversely Affects Cardiovascular Prognosis in Hypertensive Patients

Relations of left ventricular mass and systolic function to endothelial function and coronary flow reserve in healthy, new discovered hypertensive subjects

Effects of Isoflurane on Coronary Blood Flow Velocity in Young, Old and ApoE−/− Mice Measured by Doppler Ultrasound

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