Determinants of Reduction of Coronary Flow Reserve in Patients With Type 2 Diabetes Mellitus or Arterial Hypertension Without Angiographically Determined Epicardial Coronary Stenosis

Galderisi, Maurizio; Capaldo, Brunella; Sidiropulos, Milena; D’Errico, Arcangelo; Ferrara, Luigi; Turco, Annamelia; Guarini, Pasquale; Riccardi, Gabriele

doi:10.1016/j.amjhyper.2007.08.005

Cited by 63 publications

(56 citation statements)

References 26 publications

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“…Also, the negative impact of diabetes mellitus on hyperemic coronary flow was evident, as previously observed 41. Dipyridamole‐induced coronary hyperemia is endothelium independent but coronary blood flow increase may beget further flow‐induced vasodilation, which is endothelium dependent 39.…”

Section: Discussionsupporting

confidence: 73%

“…Under these circumstances, the detrimental effect of cardiovascular risk factors including arterial hypertension is recognized 23, 41, 42. It is also of interest that CFR, being the ratio between hyperemic and resting coronary flow,39 can be pathologically reduced due to the increase of denominator (coronary blood flow at rest) or the decrease of nominator (hyperemic coronary blood flow).…”

Section: Discussionmentioning

confidence: 99%

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Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Lembo

Sicari

Esposito

et al. 2017

JAHA

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BackgroundThe aim of our study was to evaluate the relationship of pulse pressure (PP), a raw index of arterial stiffness, with noninvasively determined coronary flow reserve (CFR) and its components, in patients with angiographically normal epicardial coronary arteries.Methods and ResultsThe study population included 398 patients without angiographic evidence of coronary stenosis, who underwent high‐dose dipyridamole stress echocardiography with transthoracic‐derived CFR evaluation on the left anterior descending artery. CFR was calculated as the ratio between high‐dose dipyridamole and resting coronary diastolic peak velocities. Patients were divided into 2 groups: the first group included the first and second PP tertiles (n=298, PP ≤60 mm Hg) and the second group included the highest PP tertile (n=100, PP >60 mm Hg). Mean blood pressure, systolic blood pressure (both P<0.0001), age (P<0.002), and left ventricular mass index (P=0.013) were higher in the highest PP tertile, which also showed higher resting coronary flow velocity (31.6±9.6 cm/s versus 27.7±6.4 cm/s, P<0.0001) and marginally lower CFR (2.5±0.6 versus 2.6±0.6, P=0.044). Hyperemic coronary flow velocity did not differ between the 2 groups. By separate multiple linear regression analyses, after adjusting for sex, age, the highest systolic blood pressure tertile (≥140 mm Hg), left ventricular mass index, and cardiovascular risk factors, the highest PP tertile was associated with resting coronary flow velocity (P=0.003) and only marginally with hyperemic coronary flow velocity (P<0.02), whereas its association with CFR was not significant.ConclusionsIn patients without epicardial coronary artery stenosis, the highest PP tertile is associated with an increased coronary flow velocity at rest.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Lembo

Sicari

Esposito

et al. 2017

JAHA

View full text Add to dashboard Cite

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“…Moreover, the inverse relation between coronary vasodilator response and Total Cholesterol/HDL ratio in high fat diet treated animals suggests that the relative amount of LDL has a negative impact on adenosine-mediated vasodilation, as reported in previous clinical studies [51].…”

Section: Adenosine-elicited Coronary Vasodilation and Plasma Lipoprotsupporting

confidence: 48%

HDL-Mediated Protection of Coronary Vasodilator Response to Adenosine in the Hypercholesterolemic Swine

Vozzi¹,

Pelosi²,

Puntoni³

et al. 2014

OJMIP

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“…Our findings are in line with most previous studies in the setting of essential hypertension that have exhibited an association between CFR and LV mass and geometry, as well as with myocardial diastolic function. [25][26][27][28][29] From a pathophysiological point of view, it is conceivable that changes during diastole interact with CFR impairment. In particular, diastolic time fraction is a determinant of both SEVR and coronary flow increase when the autoregulatory mechanism is exhausted because larger fractional diastolic time occurs at lower perfusion pressure, in the presence as well as in the absence of coronary stenosis.…”

Section: Coronary Flow Reserve and Buckberg Index D Tsiachris Et Almentioning

confidence: 99%

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

et al. 2011

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Subendocardial viability ratio (SEVR), calculated through pulse wave analysis, is an index of myocardial oxygen supply and demand. Our aim was to evaluate the relationship between coronary flow reserve (CFR) and SEVR in 36 consecutive untreated hypertensives (aged 57.9 years, 12 males, all Caucasian) with indications of myocardial ischaemia and normal coronary arteries in coronary angiography. CFR was calculated by a 0.014-inch Doppler guidewire (Flowire, Volcano, San Diego, CA, USA) in response to bolus intracoronary administration of adenosine (30-60 lg). SEVR was calculated by radial applanation tonometry, while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. Hypertensive patients with low CFR (n ¼ 24) compared with those with normal CFR (n ¼ 12) exhibited significantly decreased SEVR by 24.5% (P ¼ 0.002). In hypertensives with low CFR, CFR was correlated with SEVR (r ¼ 0.651, P ¼ 0.001). After applying multivariate linear regression analysis, age, left ventricular mass index, Em/Am, 24-h diastolic blood pressure (BP) and SEVR turned out to be the only independent predictors of CFR (adjusted R 2 ¼ 0.718). Estimation of SEVR by using applanation tonometry may provide a reliable tool for the assessment of coronary microcirculation in essential hypertensives with indications of myocardial ischaemia and normal coronary arteries.

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Determinants of Reduction of Coronary Flow Reserve in Patients With Type 2 Diabetes Mellitus or Arterial Hypertension Without Angiographically Determined Epicardial Coronary Stenosis

Abstract: In Type 2 DM and HTN without epicardial coronary stenosis, an impairment of CFR is demonstrable. This is partly explained by an increased left-ventricular mass, able to condition the hyperemic stimulation of myocardial blood flow.

Cited by 63 publications

References 26 publications

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

HDL-Mediated Protection of Coronary Vasodilator Response to Adenosine in the Hypercholesterolemic Swine

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

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