title: Endothelial and non-endothelial coronary blood flow reserve and left ventricular dysfunction in systemic hypertension.
abstract: OBJECTIVE
  We evaluated the impairment of endothelium-dependent and endothelium-independent coronary blood flow reserve after administration of intracoronary acetylcholine and adenosine, and its association with hypertensive cardiac disease.
  
  
  BACKGROUND
  Coronary blood flow reserve reduction has been proposed as a mechanism for the progression of compensated left ventricular hypertrophy to ventricular dysfunction.
  
  
  METHODS
  Eighteen hypertensive patients with normal epicardial coronary arteries on angiography were divided into two groups according to left ventricular fractional shortening (FS). Group 1 (FS > or =0.25): n=8, FS=0.29 +/- 0.03; Group 2 (FS <0.25): n=10, FS= 0.17 +/- 0.03.
  
  
  RESULTS
  Baseline coronary blood flow was similar in both groups (Group 1: 80.15 +/- 26.41 mL/min, Group 2: 100.09 +/- 21.51 mL/min, p=NS). In response to adenosine, coronary blood flow increased to 265.1 +/- 100.2 mL/min in Group 1 and to 300.8 +/- 113.6 mL/min (p <0.05) in Group 2. Endothelium-independent coronary blood flow reserve was similar in both groups (Group 1: 3.31 +/- 0.68 and Group 2: 2.97 +/- 0.80, p=NS). In response to acetylcholine, coronary blood flow increased to 156.08 +/- 36.79 mL/min in Group 1 and to 177.8 +/- 83.6 mL/min in Group 2 (p <0.05). Endothelium-dependent coronary blood flow reserve was similar in the two groups (Group 1: 2.08 +/- 0.74 and group Group 2: 1.76 +/- 0.61, p=NS). Peak acetylcholine/peak adenosine coronary blood flow response (Group 1: 0.65 +/- 0.27 and Group 2: 0.60 +/- 0.17) and minimal coronary vascular resistance (Group 1: 0.48 +/- 0.21 mmHg/mL/min and Group 2: 0.34 +/- 0.12 mmHg/mL/min) were similar in both groups (p= NS). Casual diastolic blood pressure and end-systolic left ventricular stress were independently associated with FS.
  
  
  CONCLUSIONS
  In our hypertensive patients, endothelium-dependent and endothelium-independent coronary blood flow reserve vasodilator administrations had similar effects in patients with either normal or decreased left ventricular systolic function.
authors.affiliation: Heart Institute, Hospital das Clínicas, da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Aloísio Marchi
authors.initials: AM
authors.lastname: Rocha
authors.forename: Vera Maria Cury
authors.initials: VM
authors.lastname: Salemi
authors.forename: Pedro Alves
authors.initials: PA
authors.lastname: Lemos Neto
authors.forename: Afonso Yoshikiro
authors.initials: AY
authors.lastname: Matsumoto
authors.forename: Valéria Fontenelle Angelim
authors.initials: VF
authors.lastname: Pereira
authors.forename: Fábio
authors.initials: F
authors.lastname: Fernandes
authors.forename: Luciano
authors.initials: L
authors.lastname: Nastari
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology; D000241:Adenosine / Q000494:pharmacology; D001783:Blood Flow Velocity / Q000502:physiology; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology*; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000494:pharmacology*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine; D000109:Acetylcholine