Epicardial coronary artery constriction to cold pressor test is predictive of cardiovascular events in hypertensive patients with angiographically normal coronary arteries and without other major coronary risk factor.
Epicardial coronary endothelial dysfunction independently predicts cardiovascular events in patients with coronary risk factors. This study was designed to evaluate outcome of hypertensive patients on the basis of their epicardial coronary function assessed by cold pressor test (CPT). Control subjects (n = 68, 48.8 +/- 7.6 years) and hypertensive patients (n = 83, 51.3 +/- 7.9 years) with angiographically normal coronary arteries and without other major coronary risk factor underwent epicardial coronary reactivity assessment to CPT using quantitative angiography. Cardiovascular events were recorded with a mean follow-up of 115 months (range 84-132). In control subjects, dilation occurred in 88.2%, no change in 11.8% (mean diameter change: +14.6 +/- 9.3%). In hypertensive patients, dilation occurred in 13.3%, no change in 25.3% (mean diameter change for both: +10.9 +/- 11.2%), and constriction in 61.4% (mean diameter change: -12.7 +/- 3.4%). Endothelium-independent dilation was normal in control subjects and hypertensive patients. In control subjects, there were three cardiovascular events in two subjects (2.9%). In hypertensive patients, there were 17 cardiovascular events in 12 patients (14.5%, P < 0.01 versus control subjects), with 15 cardiovascular events in the 10/51 patients (19.6%) with coronary artery constriction, and two cardiovascular events in the 2/32 patients (6.3%) with no change or dilation (P < 0.05). In conclusion, in hypertensive patients with angiographically normal coronary arteries and without other major coronary risk factors, epicardial coronary artery dysfunction assessed by the cold pressor test is predictive of long-term cardiovascular events.
Nitenberg
Alain
A
Service de Physiologie et d'Explorations Fonctionnelles, Centre Hospitalier Universitaire Jean Verdier, Avenue du 14 Juillet, Université Paris XIII, 93143 Bondy, France. alain.nitenberg@jvr.ap-hop-paris.fr
Chemla
Denis
D
Antony
Isabelle
I
D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D003080:Cold Temperature; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D003329:Coronary Vasospasm / Q000503:physiopathology*; D003935:Diagnostic Techniques, Cardiovascular; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011336:Probability; D016016:Proportional Hazards Models; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric