Hypertension impairs myocardial blood perfusion reserve in subjects without regional myocardial ischemia.
Quantitative analysis of myocardial perfusion MRI can provide noninvasive assessments of myocardial perfusion reserve (MPR), which is associated with endothelial function. Endothelial function is influenced by various factors, including hypertension, diabetes, dyslipidemia, renal dysfunction and anemia. The purpose of this study was to evaluate which risk factor is the strongest effector of MPR in subjects without regional myocardial ischemia. We studied 110 patients (66 years ±10, male 68%, hypertension 76%, diabetes mellitus (DM) 40% and dyslipidemia 65%) without regional myocardial ischemia. Adenosine triphosphate (ATP) stress and rest first-pass perfusion magnetic resonance (MR) images were acquired with a 1.5-T MR system, and MPR was calculated as the ratio of stress to rest myocardial blood flow (MBF). Average rest MBF in 110 patients was 1.07±0.62 ml min⁻¹ g⁻¹, whereas stress MBF was 3.15±1.93 ml min⁻¹ g⁻¹ and the MPR was 3.33±1.82. Rest MBF correlated significantly with hematocrit, whereas stress MBF showed a strong correlation with estimated glomerular filtration rate (e-GFR). MPR was associated with hypertension, age, e-GFR, hematocrit and left ventricular mass index (LVMI). In multiple regression analysis, hypertension (P=0.003, β=-0.274) showed the strongest correlation with MPR among other risk factors, such as diabetes (P=ns), dyslipidemia (P=ns), e-GFR (P=ns), LVMI (P=0.007, β=-0.248) and hematocrit (P=ns) after adjusting age and gender. Hypertension is the most important effector of MPR in subjects without myocardial ischemia.
Nakajima
Hiroshi
H
Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan.
Onishi
Katsuya
K
Kurita
Tairo
T
Ishida
Masaki
M
Nagata
Motonori
M
Kitagawa
Kakuya
K
Dohi
Kaoru
K
Nakamura
Mashio
M
Sakuma
Hajime
H
Ito
Masaaki
M
D000255:Adenosine Triphosphate / Q000032:analysis; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003287:Contrast Media; D004727:Endothelium / Q000503:physiopathology; D005260:Female; D019786:Gadolinium DTPA; D006321:Heart / Q000503:physiopathology*; D006400:Hematocrit; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology*; D055414:Myocardial Perfusion Imaging; D012039:Regional Blood Flow / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D003287:Contrast Media; D000255:Adenosine Triphosphate; D019786:Gadolinium DTPA