Incremental value of pulse wave velocity in the determination of coronary microcirculatory dysfunction in never-treated patients with essential hypertension
Incremental value of pulse wave velocity in the determination of coronary microcirculatory dysfunction in never-treated patients with essential hypertension
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DOI：
10.1038/ajh.2008.172
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发表时间：
2008-07-01
影响因子：
3.2
通讯作者：
Kremastinos, Dimitrios Th.
中科院分区：
文献类型：
--
作者：
Ikonomidis, Ignatios;Lekakis, John;Kremastinos, Dimitrios Th.
BACKGROUNDCoronary microcirculation is disturbed in essential hypertension. We investigated whether arterial stiffness determines coronary flow reserve (CFR) in hypertensive patients.METHODSWe examined 100 never-treated hypertensives and 20 healthy controls. We measured (i) carotid-to-femoral pulse wave velocity (PWV); (ii) Systolic (V-s) and diastolic (V-d) coronary flow velocity, time integral (V-TI-V-d) of diastolic velocity and CFR after adenosine by transthoracic echocardiography; (iii) ratio of E wave from mitral inflow to Em of mitral annulus, as an index of left ventricular (LV) diastolic pressures using tissue Doppler; (iv) carotid intima-media thickness (IMT), as an index of vascular damage; and (v) 24-h blood pressure parameters using ambulatory blood pressure monitoring.RESULTSPatients had abnormal PWV, IMT, E/Em, resting V-d/V-s, and CFR than controls (P < 0.05). In hypertensives, PWV was related to abnormal IMT and E/Em which in turn were related to reduced CFR (P < 0.05). PWV and E/Em were independent determinants of CFR and V-d/V-s (P < 0.05) in hypertensives. When added to a model including age, sex, smoking, LV mass (LVM), heart rate, 24-h systolic blood pressure (SBP), and E/Em, PWV had an incremental value in the determination of CFR (r(2) change from 0.25 to 0.46, P < 0.01). PWV > 10.7 m/s predicted a CFR < 2 with 79 and 75% and a CFR < 2.6 with 83 and 82% sensitivity and specificity, respectively, using adjusted-receiver operating characteristic curve (ROC) analysis.CONCLUSIONSElevated LV diastolic compressive forces on coronary microcirculation and the presence of generalized vascular damage may explain the association between PWV and CFR. PWV has an incremental value in the determination of impaired coronary microcirculation in hypertensive patients.
