Incremental Value of Pulse Wave Velocity in the Determination of Coronary Microcirculatory Dysfunction in Never-treated Patients With Essential Hypertension
Background Coronary microcirculation is disturbed in essential hypertension. We investigated whether arterial stiffness determines coronary flow reserve (CFR) in hypertensive patients. Methods We examined 100 never-treated hypertensives and 20 healthy controls. We measured (i) carotid-to-femoral pul...
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| Veröffentlicht in: | American journal of hypertension 2008-07, Vol.21 (7), p.806-813 |
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| creator | Ikonomidis, Ignatios Lekakis, John Papadopoulos, Costas Triantafyllidi, Helen Paraskevaidis, Ioannis Georgoula, Georgia Tzortzis, Stavros Revela, Ioanna Kremastinos, Dimitrios Th |
| description | Background Coronary microcirculation is disturbed in essential hypertension. We investigated whether arterial stiffness determines coronary flow reserve (CFR) in hypertensive patients. Methods We 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. Results Patients 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 |
| doi_str_mv | 10.1038/ajh.2008.172 |
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We investigated whether arterial stiffness determines coronary flow reserve (CFR) in hypertensive patients. Methods We 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. Results Patients 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. Conclusions Elevated 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.]]></description><identifier>ISSN: 0895-7061</identifier><identifier>EISSN: 1941-7225</identifier><identifier>EISSN: 1879-1905</identifier><identifier>DOI: 10.1038/ajh.2008.172</identifier><identifier>PMID: 18497732</identifier><identifier>CODEN: AJHYE6</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adenosine ; Adult ; Aged ; Blood Flow Velocity ; Blood Pressure ; Carotid Arteries - diagnostic imaging ; Carotid Arteries - physiopathology ; Case-Control Studies ; Coronary Artery Disease - etiology ; Coronary Artery Disease - physiopathology ; Coronary Circulation ; Echocardiography, Doppler, Color ; Elasticity ; Female ; Femoral Artery - diagnostic imaging ; Femoral Artery - physiopathology ; Fractional Flow Reserve, Myocardial ; Humans ; Hypertension - complications ; Hypertension - diagnostic imaging ; Hypertension - physiopathology ; Male ; Microcirculation - physiopathology ; Middle Aged ; Models, Cardiovascular ; Myocardial Contraction ; Prospective Studies ; ROC Curve ; Time Factors ; Ventricular Function, Left ; Ventricular Pressure</subject><ispartof>American journal of hypertension, 2008-07, Vol.21 (7), p.806-813</ispartof><rights>American Journal of Hypertension, Ltd. © 2008 by the American Journal of Hypertension, Ltd. 2008</rights><rights>Copyright Nature Publishing Group Jul 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c450t-c30406e4ae821ef840655289368b01c11a09340f6535dd25c56cc082030436173</citedby><cites>FETCH-LOGICAL-c450t-c30406e4ae821ef840655289368b01c11a09340f6535dd25c56cc082030436173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27913,27914</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18497732$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ikonomidis, Ignatios</creatorcontrib><creatorcontrib>Lekakis, John</creatorcontrib><creatorcontrib>Papadopoulos, Costas</creatorcontrib><creatorcontrib>Triantafyllidi, Helen</creatorcontrib><creatorcontrib>Paraskevaidis, Ioannis</creatorcontrib><creatorcontrib>Georgoula, Georgia</creatorcontrib><creatorcontrib>Tzortzis, Stavros</creatorcontrib><creatorcontrib>Revela, Ioanna</creatorcontrib><creatorcontrib>Kremastinos, Dimitrios Th</creatorcontrib><title>Incremental Value of Pulse Wave Velocity in the Determination of Coronary Microcirculatory Dysfunction in Never-treated Patients With Essential Hypertension</title><title>American journal of hypertension</title><addtitle>AJH</addtitle><description><![CDATA[Background Coronary microcirculation is disturbed in essential hypertension. We investigated whether arterial stiffness determines coronary flow reserve (CFR) in hypertensive patients. Methods We 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. Results Patients 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. Conclusions Elevated 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.]]></description><subject>Adenosine</subject><subject>Adult</subject><subject>Aged</subject><subject>Blood Flow Velocity</subject><subject>Blood Pressure</subject><subject>Carotid Arteries - diagnostic imaging</subject><subject>Carotid Arteries - physiopathology</subject><subject>Case-Control Studies</subject><subject>Coronary Artery Disease - etiology</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Circulation</subject><subject>Echocardiography, Doppler, Color</subject><subject>Elasticity</subject><subject>Female</subject><subject>Femoral Artery - diagnostic imaging</subject><subject>Femoral Artery - physiopathology</subject><subject>Fractional Flow Reserve, Myocardial</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Hypertension - diagnostic imaging</subject><subject>Hypertension - physiopathology</subject><subject>Male</subject><subject>Microcirculation - physiopathology</subject><subject>Middle Aged</subject><subject>Models, Cardiovascular</subject><subject>Myocardial Contraction</subject><subject>Prospective Studies</subject><subject>ROC Curve</subject><subject>Time Factors</subject><subject>Ventricular Function, Left</subject><subject>Ventricular Pressure</subject><issn>0895-7061</issn><issn>1941-7225</issn><issn>1879-1905</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqF0U1vEzEQBmALgWhauHFGlpDohQ3-WHu9R0hbUilAD9CiXizXmVU2bNbB9lbkv_BjmbARlbhwsmw9Mx7NS8gLzqacSfPWrVdTwZiZ8ko8IhNel7yohFCPyYSZWhUV0_yIHKe0ZoyVWvOn5Iibsq4qKSbk12XvI2ygz66j164bgIaGXg1dAnrj7oFeQxd8m3e07WleAT2DDHHT9i63od_bWYihd3FHP7Y-Io1-6FwO-HC2S83Q-z8Qqz_BPcQiR3AZlvQKG-Cvid60eUXPU8JLizPMd1uIGfqEVc_Ik8bhJM8P5wn5enH-ZTYvFp8_XM7eLQpfKpYLL1nJNJQOjODQGLwoJUwttblj3HPuWC1L1mgl1XIplFfae2YEwzqpeSVPyOux7zaGHwOkbDdt8tB1rocwJKtroVmtDMJX_8B1GGKPs1nORFmVuHyN6s2ocB8pRWjsNrYbXBEiu8_MYmZ2n5nFzJC_PDQd7jawfMCHkBCcjiAM2_-1oqPEeIYIfzGivRlJMZI2Zfj5IOJ3qytZKTv_dmvN-4ua6cWtncnfZ325gA</recordid><startdate>200807</startdate><enddate>200807</enddate><creator>Ikonomidis, Ignatios</creator><creator>Lekakis, John</creator><creator>Papadopoulos, Costas</creator><creator>Triantafyllidi, Helen</creator><creator>Paraskevaidis, Ioannis</creator><creator>Georgoula, Georgia</creator><creator>Tzortzis, Stavros</creator><creator>Revela, Ioanna</creator><creator>Kremastinos, Dimitrios Th</creator><general>Oxford University Press</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>200807</creationdate><title>Incremental Value of Pulse Wave Velocity in the Determination of Coronary Microcirculatory Dysfunction in Never-treated Patients With Essential Hypertension</title><author>Ikonomidis, Ignatios ; Lekakis, John ; Papadopoulos, Costas ; Triantafyllidi, Helen ; Paraskevaidis, Ioannis ; Georgoula, Georgia ; Tzortzis, Stavros ; Revela, Ioanna ; Kremastinos, Dimitrios Th</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c450t-c30406e4ae821ef840655289368b01c11a09340f6535dd25c56cc082030436173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adenosine</topic><topic>Adult</topic><topic>Aged</topic><topic>Blood Flow Velocity</topic><topic>Blood Pressure</topic><topic>Carotid Arteries - diagnostic imaging</topic><topic>Carotid Arteries - physiopathology</topic><topic>Case-Control Studies</topic><topic>Coronary Artery Disease - etiology</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Circulation</topic><topic>Echocardiography, Doppler, Color</topic><topic>Elasticity</topic><topic>Female</topic><topic>Femoral Artery - diagnostic imaging</topic><topic>Femoral Artery - physiopathology</topic><topic>Fractional Flow Reserve, Myocardial</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Hypertension - diagnostic imaging</topic><topic>Hypertension - physiopathology</topic><topic>Male</topic><topic>Microcirculation - physiopathology</topic><topic>Middle Aged</topic><topic>Models, Cardiovascular</topic><topic>Myocardial Contraction</topic><topic>Prospective Studies</topic><topic>ROC Curve</topic><topic>Time Factors</topic><topic>Ventricular Function, Left</topic><topic>Ventricular Pressure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ikonomidis, Ignatios</creatorcontrib><creatorcontrib>Lekakis, John</creatorcontrib><creatorcontrib>Papadopoulos, Costas</creatorcontrib><creatorcontrib>Triantafyllidi, Helen</creatorcontrib><creatorcontrib>Paraskevaidis, Ioannis</creatorcontrib><creatorcontrib>Georgoula, Georgia</creatorcontrib><creatorcontrib>Tzortzis, Stavros</creatorcontrib><creatorcontrib>Revela, Ioanna</creatorcontrib><creatorcontrib>Kremastinos, Dimitrios Th</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of hypertension</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ikonomidis, Ignatios</au><au>Lekakis, John</au><au>Papadopoulos, Costas</au><au>Triantafyllidi, Helen</au><au>Paraskevaidis, Ioannis</au><au>Georgoula, Georgia</au><au>Tzortzis, Stavros</au><au>Revela, Ioanna</au><au>Kremastinos, Dimitrios Th</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incremental Value of Pulse Wave Velocity in the Determination of Coronary Microcirculatory Dysfunction in Never-treated Patients With Essential Hypertension</atitle><jtitle>American journal of hypertension</jtitle><addtitle>AJH</addtitle><date>2008-07</date><risdate>2008</risdate><volume>21</volume><issue>7</issue><spage>806</spage><epage>813</epage><pages>806-813</pages><issn>0895-7061</issn><eissn>1941-7225</eissn><eissn>1879-1905</eissn><coden>AJHYE6</coden><abstract><![CDATA[Background Coronary microcirculation is disturbed in essential hypertension. We investigated whether arterial stiffness determines coronary flow reserve (CFR) in hypertensive patients. Methods We 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. Results Patients 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. Conclusions Elevated 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.]]></abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>18497732</pmid><doi>10.1038/ajh.2008.172</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adenosine Adult Aged Blood Flow Velocity Blood Pressure Carotid Arteries - diagnostic imaging Carotid Arteries - physiopathology Case-Control Studies Coronary Artery Disease - etiology Coronary Artery Disease - physiopathology Coronary Circulation Echocardiography, Doppler, Color Elasticity Female Femoral Artery - diagnostic imaging Femoral Artery - physiopathology Fractional Flow Reserve, Myocardial Humans Hypertension - complications Hypertension - diagnostic imaging Hypertension - physiopathology Male Microcirculation - physiopathology Middle Aged Models, Cardiovascular Myocardial Contraction Prospective Studies ROC Curve Time Factors Ventricular Function, Left Ventricular Pressure |
| title | Incremental Value of Pulse Wave Velocity in the Determination of Coronary Microcirculatory Dysfunction in Never-treated Patients With Essential Hypertension |
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