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Altered coronary flow velocity reserve and left ventricular wall motion dynamics: a phenomenon in hypertensive patients with ECG strain.

Arita, Yu; Hirata, Kumiko; Wada, Nozomi; Komukai, Kenichi; Tanimoto, Takashi; Kitabata, Hironori; Takarada, Shigeho; Nakamura, Nobuo; Kubo, Takashi; Tanaka, Atsushi; Imanishi, Toshio; Akasaka, Takashi.
Echocardiography; 30(6): 634-43, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23311501

BACKGROUND:

The inner-half layer of the left ventricular (LV) wall is primarily affected by ischemia and increased LV afterload. We hypothesized that LV wall thickening of inner-half layer and coronary microvascular function are impaired in hypertensive patients, especially in those with electrocardiographic (ECG) strain, which is a marker of LV hypertrophy and adverse prognosis. Therefore, the aim of this study is to investigate the association of the ratio of inner- to outer-half layer of the LV myocardial deformation and coronary microvascular function with ECG strain in hypertensive patients.

METHODS:

We studied 98 hypertensive patients and 13 controls. Hypertensive patients were divided into 2 groups, with (S+) and without (S-) ECG strain. Coronary flow velocity reserve (CFVR) of the left anterior descending artery was evaluated using transthoracic echocardiography. Circumferential and radial strains of the LV wall were analyzed by two-dimensional echocardiographic speckle tracking method, and the inner- to outer-half layer ratio (in/out ratio) was assessed.

RESULTS:

Coronary flow velocity reserve of S+ (2.06 ± 0.65) was significantly smaller than those in S- and controls (3.03 ± 0.65 and 3.38 ± 0.51, respectively). In/out ratio in both circumferential and radial strains were decreased as well as in S+ patients. Furthermore, in/out ratio was directly proportional to CFVR.

CONCLUSIONS:

Hypertensive patients with ECG strain possessed severely impaired CFVR and inner-half myocardial deformation. Moreover, the more severe the LV hypertrophy progresses, the greater is the impairment of coronary microvascular and LV inner-half myocardial deformation. Thus, CFVR and in/out ratio are useful quantitative markers that can render sensitive assessment of physiological changes in hypertensive heart disease.
Selo DaSilva