Key result
In hypertensive patients, endothelium-dependent and endothelium-independent coronary blood flow reserve were similar in those with decreased versus normal left ventricular systolic function.
Why the study?
Does left ventricular systolic dysfunction affect endothelium-dependent and endothelium-independent coronary blood flow reserve in hypertensive patients?
Observational (n=18)
Does left ventricular systolic dysfunction affect endothelium-dependent and endothelium-independent coronary blood flow reserve in hypertensive patients?
Endothelium-dependent and endothelium-independent coronary blood flow reserve are not significantly impaired in hypertensive patients with decreased left ventricular systolic function compared to those with normal function.
Answers are grounded in this paper and cite their sources.
Coronary flow reserve is similar in hypertensive patients regardless of LV systolic function; leaves open whether dysfunction independently impairs microvascular reserve.
OBJECTIVES: We evaluated the impairment of endothelium-dependent and endothelium-independent coronary blood flow reserve after administration of intracoronary acetylcholine and adenosine, and its association with hypertensive cardiac disease. INTRODUCTION: Coronary blood flow reserve reduction has been proposed as a mechanism for the progression of compensated left ventricular hypertrophy to ventricular dysfunction. METHODS: Eighteen hypertensive patients with normal epicardial coronary arteries on angiography were divided into two groups according to left ventricular fractional shortening (FS). Group 1 (FS > or =0.25): n=8, FS=0.29 +/- 0.03; Group 2 (FS <0.25): n=10, FS= 0.17 +/- 0.03. RESULTS: Baseline coronary blood flow was similar in both groups (Group 1: 80.15 +/- 26.41 mL/min, Group 2: 100.09 +/- 21.51 mL/min, p=NS). In response to adenosine, coronary blood flow increased to 265.1 +/- 100.2 mL/min in Group 1 and to 300.8 +/- 113.6 mL/min (p <0.05) in Group 2. Endothelium-independent coronary blood flow reserve was similar in both groups (Group 1: 3.31 +/- 0.68 and Group 2: 2.97 +/- 0.80, p=NS). In response to acetylcholine, coronary blood flow increased to 156.08 +/- 36.79 mL/min in Group 1 and to 177.8 +/- 83.6 mL/min in Group 2 (p <0.05). Endothelium-dependent coronary blood flow reserve was similar in the two groups (Group 1: 2.08 +/- 0.74 and group Group 2: 1.76 +/- 0.61, p=NS). Peak acetylcholine/peak adenosine coronary blood flow response (Group 1: 0.65 +/- 0.27 and Group 2: 0.60 +/- 0.17) and minimal coronary vascular resistance (Group 1: 0.48 +/- 0.21 mmHg/mL/min and Group 2: 0.34 +/- 0.12 mmHg/mL/min) were similar in both groups (p= NS). Casual diastolic blood pressure and end-systolic left ventricular stress were independently associated with FS. CONCLUSIONS: In our hypertensive patients, endothelium-dependent and endothelium-independent coronary blood flow reserve vasodilator administrations had similar effects in patients with either normal or decreased left ventricular systolic function.
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Rocha et al. (2009) conducted an observational in Systemic Hypertension (n=18). Decreased left ventricular systolic function (fractional shortening <0.25) vs. Normal left ventricular systolic function (fractional shortening ≥0.25) was evaluated on Endothelium-independent coronary blood flow reserve (p=NS). In hypertensive patients, endothelium-dependent and endothelium-independent coronary blood flow reserve were similar in those with decreased versus normal left ventricular systolic function.
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