Association of abnormal coronary microcirculatory function with impaired response of longitudinal left ventricular function during adenosine stress echocardiography in untreated hypertensive patients
Association of abnormal coronary microcirculatory function with impaired response of longitudinal left ventricular function during adenosine stress echocardiography in untreated hypertensive patients
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DOI：
10.1093/ehjci/jes071
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发表时间：
2012-12-01
影响因子：
6.2
通讯作者：
Lekakis, John
中科院分区：
文献类型：
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作者：
Ikonomidis, Ignatios;Tzortzis, Stavros;Lekakis, John
高血压患者存在冠状动脉微循环障碍。我们研究了冠状动脉血流储备（CFR）与左心室（LV）功能的反应之间的关系，通过组织多普勒成像（TDI）在腺苷负荷超声心动图中评估从未治疗过的高血压患者。我们研究了90例高血压患者和30例对照组，年龄和性别相匹配，腺苷负荷超声心动图。我们测量了：（i）CFR、E和A多普勒、S、E、A二尖瓣环速度和TDI，以及腺苷输注前和输注期间的E/A比值和E/E比值。（ii）基线和腺苷输注之间测量的指标的变化。腺苷输注后，所有患者和对照组的S、E和A均增加（P 0.05）。与对照组和CFR <2.5的患者相比，CFR <2.5的患者的S增加较小，（28.6 vs. 30.0 vs. 11.1，F代表相互作用14.592）和E（33.3 vs. 33.3 vs. 1.5，F 28.927）以及E/A降低（9.2 vs. 6.4 vs. 20.0，F 5.128）和E/E增加（6.1 vs. 1.6 vs. 30.5）。F 12.780）（所有比较P 0.05）。CFR与TDI参数变化独立相关（S的回归系数B 0.576; E的回归系数B 0.517; E/A的回归系数B 0.473; E/E的回归系数B 0.520，P 0.001）。根据受试者工作曲线，CFR 2.5预测了所有测量的TDI标记物的中位变化，灵敏度和特异性均超过70（AUC 75，P 0.05）。腺苷负荷超声心动图期间LV纵向功能的异常反应与未经治疗的高血压患者的CFR受损有关。
Coronary microcirculation is disturbed in hypertensive patients. We investigated the association of coronary flow reserve (CFR) with the response of left ventricular (LV) function as assessed by tissue Doppler imaging (TDI) during adenosine stress echocardiography in never-treated hypertensive patients.We studied 90 hypertensive patients and 30 control subjects, matched for age and sex, by adenosine stress echocardiography. We measured: (i) CFR, E and A Doppler, S, E, A mitral annulus velocities with TDI, as well as the E/A ratio and the E/E ratio before and during adenosine infusion (ii) the changes of the measured indices between baseline and adenosine infusion. After adenosine infusion, there was an increase in S, E, and A in all patients and controls (P 0.05). Compared with controls and patients with CFR epsilon 2.5, patients with CFR 2.5 showed a smaller increase in S (28.6 vs. 30.0 vs. 11.1, F for interaction 14.592) and E (33.3 vs. 33.3 vs.1.5, F 28.927) as well as a decrease in E/A (9.2 vs. 6.4 vs. 20.0, F 5.128) and an increase in E/E (6.1 vs. 1.6 vs. 30.5. F 12.780) after adenosine infusion (P 0.05 for all comparisons). CFR was independently related to changes of TDI parameters (regression coefficient b 0.576 for S; b 0.517 for E; b 0.473 for E/A; b 0.520 for E/E, respectively, P 0.001). By the receiver operating curve, a CFR 2.5 predicted the median changes of all measured TDI markers, with a sensitivity and specificity over 70 (AUC 75, P 0.05).An abnormal response of the LV longitudinal function during adenosine stress echocardiography is related to impaired CFR in untreated hypertensive patients.