[Intravenous adenosine infusion in the assessment of coronary flow reserve in hypertension. Transesophageal Doppler echocardiographic study].
In hypertensive patients with normal coronary angiography typical chest pain may be caused by microvascular coronary artery disease. This can be confirmed by decreased coronary flow reserve (CFR). Adenosine test with transesophageal echocardiography was chosen for the measurement of CFR. There are only few reports in the literature which utilized this test. The purpose of this study was primarily to further elucidate some technical aspects and to evaluate CFR in hypertensive patients with angina, positive stress test and normal coronary angiography. Out of 12 such consecutive patients the adenosine test was successful in 11. Adenosine was given in 140 mcg/kg/min dose as a 5 minute continuous infusion. Mean coronary flow velocity (Vm), CFR, baseline coronary flow resistance (CVR) and maximal coronary dilation (CRR) in the left anterior descending artery were measured and calculated by multiplane transesophageal Doppler echocardiography. There was a 43% increase of heart rate and a 7% decrease of systolic blood pressure. Baseline Vm was 36 +/- 16 cm/s, CFR 2.4 +/- 0.4, baseline CVR was 2.8 +/- 1.0 mmHg/s/an, CRR was 2.4 +/- 0.4. Left main coronary dimension did not change. There was no important side effect. While baseline Vm was similar to normal values in the literature, CFR and CRR were decreased compared to normals. There was no correlation between baseline Vm or heart rate and CFR but a direct correlation was found between baseline CVR and CRR (r = 0.54). Peak effect of adenosine was achieved at 3-5 minutes.


CONCLUSIONS
Adenosine-TEE infusion test is a safe and easy to perform technique to assess CFR in hypertensive patients. In hypertensive patients with documented ischemia and normal coronary angiography the coronary flow reserve is decreased.
D000241:Adenosine / Q000008:administration & dosage; D000328:Adult; D003326:Coronary Circulation / Q000502:physiology*; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged