Clinical implications of assessing coronary flow velocity reserve and plasma endothelin-1 in hypertensive patients.
Previous reports have indicated that hypertensive patients who have angina-like chest pain and normal coronary arteriograms have reduced coronary flow velocity reserve (CFVR) levels. In addition, elevated plasma endothelin-1 (ET-1) levels have been reported to be associated with microvascular angina. The purpose of this study was to evaluate the plasma ET-1 levels and CFVR in patients with chest pain but without coronary artery disease (CAD). A total of 66 patients were included in this study. CAD was ruled out by exercise stress test or coronary angiogram. Plasma ET-1 and CFVR measurements were performed in patients with (n=35) and without (n=31) a history of angina-like chest pain. CFVR was measured using adenosine-triphosphate stress transthoracic Doppler echocardiography. The mean ET-1 level was significantly higher and the CFVR was significantly lower in patients in the symptomatic group than in those in the asymptomatic group (ET-1: 3.85 +/- 1.24 pg/ml vs. 2.98 +/- 1.27 pg/ml, CFVR: 2.26 +/- 0.48 vs. 2.77 +/- 0.11, respectively). Plasma ET-1 level and CFVR were significantly correlated with each other (-r = 0.265, p = 0.033). Age, blood pressure, cardiovascular risk factors, and left ventricular mass index were similar between the two groups. The results of multiple regression analysis indicate that age (p = 0.008) and plasma ET-1 concentration (p = 0.031) had statistically independent associations with CFVR. Attenuated CFVR in the symptomatic hypertensive patients was associated with endothelial dysfunction, which results in elevated plasma ET-1 levels. The link between these two parameters may play a role in the genesis of chest pain in hypertensive patients without CAD.
Division of Hypertension and Nephrology, National Cardiovascular Center, Suita, Japan. hideki-f@tg7.so-net.ne.jp
Hideki
H
Fujii
Shin
S
Takiuchi
Kei
K
Kamide
Takeshi
T
Horio
Shin-ichirou
S
Niizuma
Norio
N
Tanaka
Shuji
S
Hashimoto
Satoshi
S
Nakatani
Masafumi
M
Fukagawa
Yuhei
Y
Kawano
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D002637:Chest Pain / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology*; D004452:Echocardiography; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged
D019332:Endothelin-1