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CLINICAL STUDIES

Attenuated coronary flow reserve and vascular remodeling in patients with hypertension and left ventricular hypertrophy

^a Center for Coronary Physiology and Imaging, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Manuscript received October 13, 1998; revised manuscript received December 3, 1999, accepted January 17, 2000.

Reprint requests and correspondence: Dr. Amir Lerman, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
lerman.amir{at}mayo.edu

OBJECTIVES

The purpose of this study was to evaluate the association between hypertension and left ventricular hypertrophy (LVH) with both coronary vascular remodeling and endothelial function.

BACKGROUND

The association between endothelial and nonendothelial coronary flow reserve with vascular remodeling in patients with hypertension and LVH is still unclear.

METHODS

One hundred and eleven patients with normal or mildly diseased coronary arteries at angiography underwent intravascular ultrasound examination of the left anterior descending coronary artery. Patients were divided into three groups: group 1: n = 13, hypertensive patients with LVH; group 2: n = 30, hypertensive patients without LVH; group 3: n = 68, normotensive patients. Vessel and lumen area and atherosclerotic plaque area were evaluated. Vascular reactivity was examined using intracoronary adenosine and acetylcholine.

RESULTS

Vessel area in group 1 (with LVH) was significantly (p < 0.01) greater than that in group 2 (without LVH), whereas, vessel area in both groups 1 and 3 was similar (12.8 ± 0.8 mm², 10.7 ± 0.4 mm² and 11.5 ± 0.3 mm²). Coronary blood flow at baseline for patients in group 1 (with LVH) was significantly greater than it was for patients in groups 2 and 3 (81.1 ± 9.9 ml/min, 56.5 ± 6.2 ml/min and 48.1 ± 3.2 ml/min, both p < 0.05). In comparison with groups 2 and 3, the response to both acetylcholine and adenosine was significantly impaired in patients with LVH.

CONCLUSIONS

The current study demonstrates that hypertension with LVH is associated with both coronary vascular remodeling and attenuated endothelial and nonendothelial coronary flow reserve.

Abbreviations and Acronyms   BSA = body surface area   CBF = coronary blood flow   CFR = coronary flow reserve   IVS = septal thickness at end-diastole   LVDd = left ventricular end-diastolic   LVDs = left ventricular end-systolic   LVH = left ventricular hypertrophy   LVID = left ventricular internal dimension at end-diastole   LVM = left ventricular mass   LVMI = left ventricular mass index   PW = posterior wall

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