Evaluation of coronary flow reserve in hypertensive patients by dipyridamole transesophageal Doppler echocardiography

This study evaluates the coronary flow reserve (CFR) in hypertensive patien ts with and without left ventricular (LV) hypertrophy. CFR was assessed by transesophageal Doppler echocardiography in 15 normal subjects (group I), 2 1 hypertensive patients without LV hypertrophy (group II), and 27 hypertens ive patients with LV hypertrophy (group III). All hypertensive patients wer e complaining of typical anginal pain and had normal coronary angiograms. T he sample volume was placed at the bifurcation of the left main and left an terior descending coronary arteries. Coronary blood flow velocities were ev aluated at rest, 2 minutes after dipyridamole infusion, and 2 minutes after intravenous aminophylline. The ratios of dipyridamole to rest peak diastol ic and systolic velocities were considered as indexes of CFR. Peak diastoli c velocity ratio was significantly lower in group III than in groups I and II (1.6 +/- 0.2 2.7 +/- 0.4, and 2.1 +/- 0.2, respectively p <0.05), and it was significantly lower in group II then I (p <0.05). The peek systolic ve locity ratio was significantly lower in group III than in groups I and II ( 1.7 +/- 0.3, 2.8 +/- 0.3, and 2.1 +/- 0.2, respectively; p <0.05), and it w as significantly lower in group II than I (p <0.05). The peak diastolic vel ocity ratio was inversely related to systolic blood pressure, diastolic blo od pressure, and LV mass index (r = -0.48, -0.51, and -0.37 respectively) i n hypertensive patients. It is concluded that CFR is significantly impaired in hypertensive patients, especially those with LV hypertrophy, compared w ith healthy subjects. The degree of impairment of CFR is related to LV mass index. (C) 2000 by Excerpta Medica, Inc.