Coronary flow reserve and myocardial diastolic dysfunction in arterial hypertension
Abstract
The aim of this study was to assess the relation between coronary blood flow and left ventricular (LV) myocardial diastolic dysfunction in arterial hypertension. The study population included 30 hypertensive patients who were free of coronary artery disease and pharmacologic therapies. They underwent standard Doppler echocardiography and color tissue Doppler of the middle posterior septum at baseline and with high-dose dobutamine, and second-harmonic Doppler flow analysis of the distal left anterior descending coronary artery at baseline and after vasodilation by dipyridamole (0.56 mg/kg IV in 4'). Coronary flow reserve (CFR) was estimated as the ratio of hyperemic and baseline diastolic flow velocities. According to CFR, hypertensives were divided into 2 groups: 15 patients with normal CFR (>/=2) and 15 patients with reduced CFR (<2). The 2 groups were comparable for sex, age, body mass index, baseline heart rate, and blood pressure. LV mass index was greater in hypertensives with reduced CFR (p <0.01). By color tissue Doppler, baseline and high-dose dobutamine septal systolic velocities did not differ between the 2 groups. The ratio between myocardial velocities in early diastole and at atrial contraction (E(m)/A(m) ratio) was lower in patients with reduced CFR, both at baseline (p <0.05) and with high-dose dobutamine (p <0.00001). After adjusting for age, body mass index, LV mass index, and both high-dose dobutamine diastolic blood rate and heart rate by a multiple linear regression analysis, E(m)/A(m) ratio at high-dose dobutamine was independently associated with CFR in the overall population (beta 0.62, p <0.0005) (cumulative R(2) 0.38, p <0.0005). In conclusion, this study provides evidence of an independent association between CFR and myocardial diastolic function. In hypertensive patients without coronary artery stenosis, CFR alteration may be a determinant of myocardial diastolic dysfunction or diastolic impairment that should be taken into account as possibly contributing to coronary flow reduction.
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In patients with hypertension and/or T1DM, an impaired coronary flow reserve is associated with diastolic dysfunction and with amount of ventricular EAT.
“As evidence, in patients with hypertension and/or T1DM, an impaired coronary flow reserve has been associated with diastolic dysfunction, and, more recently, with amount of ventricular EAT [98,99].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [98]
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- Authors
- Galderisi, M., Cicala, S., Caso, P., De Simone, L., D’Errico, A., Petrocelli, A., & de Divitiis, O.
- Affiliations
- Federico II University Hospital (IT)
- University of Campania "Luigi Vanvitelli" (IT)
- Ospedale Monaldi (IT)
- Corresponding author
- Galderisi, Maurizio
- ORCID
- Galderisi, Maurizio
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2002-10
- Volume
- 90
- Issue
- 8
- Pages
- 860-864
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2083752631
- Cited by
- 140
- References
- 32
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 4 · 2016: 5 · 2015: 7 · 2014: 4 · 2013: 8 · 2012: 11
- FWCI
- 4.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- coronary flow reserve, hypertension, left ventricular diastolic function, dipyridamole, dobutamine, E/A ratio, left ventricular mass, coronary microvascular dysfunction
- MeSH terms
- Adult, Blood Flow Velocity, Cardiac Volume, Coronary Circulation, Diastole, Dose-Response Relationship, Drug, Female, Humans, Hypertension, Male, Middle Aged, Myocardial Contraction, Reference Values, Regional Blood Flow, Echocardiography, Doppler, Hypertrophy, Left Ventricular, Ventricular Dysfunction, Left, Echocardiography, Doppler, Color, Echocardiography, Stress
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