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Influence of concentric remodeling on coronary flow reserve in uncomplicated essential hypertension with normal left ventricular mass
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AJH–APRIL 2000 –VOL. 13, NO. 4, PART 2
ASH XV ABSTRACTS
A012 INFLUENCE OF CONCENTRIC REMODELING ON CORONARY FLOW RESERVE IN UNCOMPLICATED ESSENTIAL HYPERTENSION WITH NORMAL LEFT VENTRICULAR MASS K. Matsuzaki, M. Mukai, K. Takatsugi, and E. Murakami* Hypertension Center, Kinki Central Hospital, Itami, Hyogo, Japan A reduced coronary flow reserve (CFR) is reported to be present already even in early stage of hypertension without left ventricular (LV) hypertrophy. The purpose of this study was to test the hypothesis whether LV geometric change (concentric remodeling) may be responsible for an impairment of CFR in uncomplicated hypertension with normal LV mass. From untreated patients with essential hypertension and normal LV mass (ⱕ115 g/m2) on echocardiography, we selected sex- and age-matched two groups determined by relative wall thickness (RWT); patients with normal LV geometry (RWT ⬍ 0.45, n ⫽ 30), patients with concentric remodeling (RWT ⱖ 0.45, n ⫽ 7). All patients underwent treadmill electrocardiography and/or coronary angiography to exclude coronary artery diseases. We assessed the washout rate (WR) obtained from intravenous dipyridamole thallium myocardial images (at 5 min and 240 min after dipyridamole and subsequent thallium injection) as a noninvasive marker of CFR. The following variables were evaluated between the two groups; WR, blood pressure (BP) level (office BP and 24-h ambulatory BP), LV fractional shortening determined by echocardiography, total cholesterol level and fasting glucose level. The WR was significantly decreased in patients with concentric remodeling than in those with normal LV geometry (33.1 ⫾ 6.8 vs 40.2 ⫾ 11.2%, P ⫽ 0.03). There were no significant differences in BP level, LV fractional shortening, total cholesterol level and fasting glucose level between these two groups. These findings indicate that a change of LV geometry from normal LV geometry to concentric remodeling may be associated strongly with the reduction in CFR in uncomplicated essential hypertension with normal LV mass. Key Words: Hypertension; coronary flow reserve; remodeling A013 GENDER DIFFERENCE IN SYSTOLIC ARTERIAL PRESSURE DROP DURING ADENOSINE MYOCARDIAL PERFUSION STUDIES IN SUBJECTS WITH ABNORMAL SCANS S.P. Kumar, W.C. Reeves, M.J. Swanson, A. Movahed East Carolina University, Greenville, North Carolina, USA Purpose: Adenosine is a pharmacological stress agent that is used in conjunction with radionuclide myocardial perfusion imaging (MPI) in the evaluation of CAD. Male and female may have different hemodynamic response during adenosine infusion. There is insufficient data regarding the gender difference in the SAP drop during adenosine myocardial perfusion studies. Our objective was to determine if there is a difference in the SAP drop between male and female in subjects with abnormal myocardial perfusion scans.
Methods: We evaluated 270 consecutive subjects (72 males and 198 females with mean age of 60 years) who had drop in SAP of 10 mm/Hg or more while undergoing radionuclide MPI using adenosine as a pharmacological stress agent. We compared the relation between drop in SAP of 10 and 20 mm/Hg to adenosine induced transient or partially reversible and fixed myocardial perfusion defect between males and females. Subjects were divided into two groups. Group I-Subjects with fixed perfusion defect (previous myocardial infarction or scar) and Group II- Subjects with transient or partially reversible perfusion defect (myocardial ischemia and/or infarction). Results:
Male Female p value
SAP drop > 10 mm/Hg
SAP drop > 20 mm/Hg
Group I
Group I
Group II
8/48 (16.7%) 6/136 (4.4%) .01
7/48 (14.6%) 5/136 (3.7%) .015
13/72 (18.1%) 7/198 (3.5%) .0005
Group II 10/72 (14%) 9/198 (4.5%) .014
Conclusion: In subjects with abnormal myocardial perfusion scans, the incidence of drop in the SAP during adenosine pharmacological stress testing was significantly higher in male than female. Key Words: Adenosine; hypertension; coronary artery disease A014 IMPACT OF LEFT VENTRICULAR HYPERTROPHY ON REGIONAL DIASTOLIC FUNCTION: ANALYSIS BY DOPPLER MYOCARDIAL IMAGING M.Z. Deljanin Ilic, S.N. Ilic, D. Djordjevic, B.K. Lovic, I.S. Tasic Institute of Cardiology, Niska Banja, University of Nis, Yugoslavia The aim of the study was to assess the impact of left ventricular hypertrophy (LVH) on regional diastolic wall motion velocity changes using Doppler myocardial imaging (DMI). Study population consisted of 25 hypertensive patients (pts) with LVH free of coronary artery disease (H group) and 20 normal controls (N group). In both groups mitral annular velocities during diastole by DMI were recorded and Eann/Aann ratio was calculated. In order to evaluate regional diastolic function in the DMI examination of left ventricular (LV) interventricular septum (IVS) and LV posterior wall (PW) in the short-axis view we measured peak velocities of early (E) and late (A) diastolic waves and calculated the E/A ratio (index of regional diastolic function). Ratio Eann/Aann was significantly bigger in N than in H group (P ⬍ 0.001). Value of E diastolic wave of IVS and PW was significantly lower in H than in N group (P ⬍ 0.001), while value of A diastolic wave of IVS and PW was significantly bigger in H than in N group (P ⬍ 0.001). Value of E/A ratio of IVS as well as of PW was significantly lower in H than in N group (IVS: 0.81 ⫾ 0.21 vs 1.49 ⫾ 0.19, P ⬍ 0.001; PW: 0.79 ⫾ 0.18 vs 1.54 ⫾ 0.20, P ⬍ 0.001). In the H group regional E/A ratio of IVS and PW was related to M mode determined septal and posterior wall thickness (r ⫽ ⫺0.442,
AJH–APRIL 2000 –VOL. 13, NO. 4, PART 2
ASH XV ABSTRACTS
A012 INFLUENCE OF CONCENTRIC REMODELING ON CORONARY FLOW RESERVE IN UNCOMPLICATED ESSENTIAL HYPERTENSION WITH NORMAL LEFT VENTRICULAR MASS K. Matsuzaki, M. Mukai, K. Takatsugi, and E. Murakami* Hypertension Center, Kinki Central Hospital, Itami, Hyogo, Japan A reduced coronary flow reserve (CFR) is reported to be present already even in early stage of hypertension without left ventricular (LV) hypertrophy. The purpose of this study was to test the hypothesis whether LV geometric change (concentric remodeling) may be responsible for an impairment of CFR in uncomplicated hypertension with normal LV mass. From untreated patients with essential hypertension and normal LV mass (ⱕ115 g/m2) on echocardiography, we selected sex- and age-matched two groups determined by relative wall thickness (RWT); patients with normal LV geometry (RWT ⬍ 0.45, n ⫽ 30), patients with concentric remodeling (RWT ⱖ 0.45, n ⫽ 7). All patients underwent treadmill electrocardiography and/or coronary angiography to exclude coronary artery diseases. We assessed the washout rate (WR) obtained from intravenous dipyridamole thallium myocardial images (at 5 min and 240 min after dipyridamole and subsequent thallium injection) as a noninvasive marker of CFR. The following variables were evaluated between the two groups; WR, blood pressure (BP) level (office BP and 24-h ambulatory BP), LV fractional shortening determined by echocardiography, total cholesterol level and fasting glucose level. The WR was significantly decreased in patients with concentric remodeling than in those with normal LV geometry (33.1 ⫾ 6.8 vs 40.2 ⫾ 11.2%, P ⫽ 0.03). There were no significant differences in BP level, LV fractional shortening, total cholesterol level and fasting glucose level between these two groups. These findings indicate that a change of LV geometry from normal LV geometry to concentric remodeling may be associated strongly with the reduction in CFR in uncomplicated essential hypertension with normal LV mass. Key Words: Hypertension; coronary flow reserve; remodeling A013 GENDER DIFFERENCE IN SYSTOLIC ARTERIAL PRESSURE DROP DURING ADENOSINE MYOCARDIAL PERFUSION STUDIES IN SUBJECTS WITH ABNORMAL SCANS S.P. Kumar, W.C. Reeves, M.J. Swanson, A. Movahed East Carolina University, Greenville, North Carolina, USA Purpose: Adenosine is a pharmacological stress agent that is used in conjunction with radionuclide myocardial perfusion imaging (MPI) in the evaluation of CAD. Male and female may have different hemodynamic response during adenosine infusion. There is insufficient data regarding the gender difference in the SAP drop during adenosine myocardial perfusion studies. Our objective was to determine if there is a difference in the SAP drop between male and female in subjects with abnormal myocardial perfusion scans.
Methods: We evaluated 270 consecutive subjects (72 males and 198 females with mean age of 60 years) who had drop in SAP of 10 mm/Hg or more while undergoing radionuclide MPI using adenosine as a pharmacological stress agent. We compared the relation between drop in SAP of 10 and 20 mm/Hg to adenosine induced transient or partially reversible and fixed myocardial perfusion defect between males and females. Subjects were divided into two groups. Group I-Subjects with fixed perfusion defect (previous myocardial infarction or scar) and Group II- Subjects with transient or partially reversible perfusion defect (myocardial ischemia and/or infarction). Results:
Male Female p value
SAP drop > 10 mm/Hg
SAP drop > 20 mm/Hg
Group I
Group I
Group II
8/48 (16.7%) 6/136 (4.4%) .01
7/48 (14.6%) 5/136 (3.7%) .015
13/72 (18.1%) 7/198 (3.5%) .0005
Group II 10/72 (14%) 9/198 (4.5%) .014
Conclusion: In subjects with abnormal myocardial perfusion scans, the incidence of drop in the SAP during adenosine pharmacological stress testing was significantly higher in male than female. Key Words: Adenosine; hypertension; coronary artery disease A014 IMPACT OF LEFT VENTRICULAR HYPERTROPHY ON REGIONAL DIASTOLIC FUNCTION: ANALYSIS BY DOPPLER MYOCARDIAL IMAGING M.Z. Deljanin Ilic, S.N. Ilic, D. Djordjevic, B.K. Lovic, I.S. Tasic Institute of Cardiology, Niska Banja, University of Nis, Yugoslavia The aim of the study was to assess the impact of left ventricular hypertrophy (LVH) on regional diastolic wall motion velocity changes using Doppler myocardial imaging (DMI). Study population consisted of 25 hypertensive patients (pts) with LVH free of coronary artery disease (H group) and 20 normal controls (N group). In both groups mitral annular velocities during diastole by DMI were recorded and Eann/Aann ratio was calculated. In order to evaluate regional diastolic function in the DMI examination of left ventricular (LV) interventricular septum (IVS) and LV posterior wall (PW) in the short-axis view we measured peak velocities of early (E) and late (A) diastolic waves and calculated the E/A ratio (index of regional diastolic function). Ratio Eann/Aann was significantly bigger in N than in H group (P ⬍ 0.001). Value of E diastolic wave of IVS and PW was significantly lower in H than in N group (P ⬍ 0.001), while value of A diastolic wave of IVS and PW was significantly bigger in H than in N group (P ⬍ 0.001). Value of E/A ratio of IVS as well as of PW was significantly lower in H than in N group (IVS: 0.81 ⫾ 0.21 vs 1.49 ⫾ 0.19, P ⬍ 0.001; PW: 0.79 ⫾ 0.18 vs 1.54 ⫾ 0.20, P ⬍ 0.001). In the H group regional E/A ratio of IVS and PW was related to M mode determined septal and posterior wall thickness (r ⫽ ⫺0.442,