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CLINICAL STUDY

Noninvasive assessment of microvascular function in arterial hypertension by transthoracic doppler harmonic echocardiography

Thomas Bartel, MD^*,*, Y. a Yang, MD^*, Silvana Müller, MD, René R. Wenzel, MD, Dietrich Baumgart, MD^*, Thomas Philipp, MD and Raimund Erbel, MD, FACC^*

^* Cardiology Division, Department of Internal Medicine, University of EssenEssen, Germany
Cardiology Division, Department of Internal Medicine, University of Innsbruck, Innsbruck, Austria
Division of Nephrology and Hypertension, Department of Internal Medicine, University of Essen, Essen, Germany

Manuscript received November 29, 2001; revised manuscript received March 19, 2002, accepted April 3, 2002.

^* Reprint requests and correspondence: Dr. Thomas Bartel, Division of Cardiology, Department of Internal Medicine, University of Essen, Hufelandstr. 55, 45122 Essen, Germany.
thomas.bartel{at}uni-essen.de

OBJECTIVES: The present study sought to investigate the use of transthoracic Doppler harmonic echocardiography (TTDHE) to evaluate changes in coronary flow dynamics due to microvascular dysfunction.

BACKGROUND: Coronary flow velocity reserve (CFVR) measurements by TTDHE are useful for assessing epicardial coronary artery stenoses. It remains unclear, however, if microvascular disease can be detected.

METHODS: In 54 patients with chest pain, intracoronary Doppler (ICD) and TTDHE were used to measure average peak velocity at baseline and hyperemia. Significant coronary lesions had been ruled out by both angiography and intravascular ultrasound. Comparative measurements were performed in the distal left anterior descending coronary artery after intracoronary and intravenous administration of adenosine, and CFVR was calculated. Hypertensive patients (n = 25) were studied and compared to a control group (26 normotensive individuals).

RESULTS: Three patients (5%) had to be excluded because of insufficient image quality or side effects. In both groups, TTDHE-derived CFVR data correlated closely with ICD measurements (group 1: y = 0.67x + 0.076, standard error of estimate [SEE] = 0.25, r = 0.87, p < 0.001; group 2: y = 0.64x + 1.11, SEE = 0.26, r = 0.87, p < 0.001). CFVR was lower in hypertensives than in normotensive controls (2.44 ± 0.49 vs. 3.33 ± 0.40, p < 0.001, cut point = 2.84).

CONCLUSIONS: The newly described echocardiographic method is suitable for assessing microvascular dysfunction noninvasively and corresponds well to invasive measurements.

Abbreviations and Acronyms   APV   average peak velocity   bAPV   baseline average peak velocity   bMDV   baseline mean diastolic velocity   bMSV   baseline mean systolic velocity   bPSV   baseline peak systolic velocity   CFVR   coronary flow velocity reserve   hAPV   hyperemic average peak velocity   ICD   intracoronary Doppler   MDV   mean diastolic velocity   MSV   mean systolic velocity   PDV   peak diastolic velocity   PSV   peak systolic velocity   TTDHE   transthoracic Doppler harmonic echocardiography

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