title: Association of abnormal coronary microcirculatory function with impaired response of longitudinal left ventricular function during adenosine stress echocardiography in untreated hypertensive patients.
abstract: OBJECTIVE
  Coronary microcirculation is disturbed in hypertensive patients. We investigated the association of coronary flow reserve (CFR) with the response of left ventricular (LV) function as assessed by tissue Doppler imaging (TDI) during adenosine stress echocardiography in never-treated hypertensive patients.
  
  
  RESULTS
  We studied 90 hypertensive patients and 30 control subjects, matched for age and sex, by adenosine stress echocardiography. We measured: (i) CFR, E and A Doppler, S', E', A' mitral annulus velocities with TDI, as well as the E'/A' ratio and the E/E' ratio before and during adenosine infusion (ii) the %changes of the measured indices between baseline and adenosine infusion. After adenosine infusion, there was an increase in S', E', and A' in all patients and controls (P < 0.05). Compared with controls and patients with CFR ≥ 2.5, patients with CFR <2.5 showed a smaller increase in S' (28.6 vs. 30.0 vs. 11.1%, F for interaction = 14.592) and E' (33.3 vs. 33.3 vs.1.5%, F = 28.927) as well as a decrease in E'/A' (9.2 vs. 6.4% vs. -20.0%, F = 5.128) and an increase in E/E' (-6.1 vs. -1.6 vs. 30.5%. F = 12.780) after adenosine infusion (P < 0.05 for all comparisons). CFR was independently related to %changes of TDI parameters (regression coefficient b = 0.576 for S'; b = 0.517 for E'; b = 0.473 for E'/A'; b = -0.520 for E/E', respectively, P < 0.001). By the receiver operating curve, a CFR <2.5 predicted the median changes of all measured TDI markers, with a sensitivity and specificity over 70% (AUC >75%, P < 0.05).
  
  
  CONCLUSIONS
  An abnormal response of the LV longitudinal function during adenosine stress echocardiography is related to impaired CFR in untreated hypertensive patients.
authors.affiliation: 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari 12462, Greece. ignoik@otenet.gr
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: Stavros
authors.initials: S
authors.lastname: Tzortzis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.forename: Helen
authors.initials: H
authors.lastname: Triantafyllidi
authors.forename: Costas
authors.initials: C
authors.lastname: Papadopoulos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papadakis
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Trivilou
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
mesh_terms: D000241:Adenosine; D000704:Analysis of Variance; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D003326:Coronary Circulation; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*
chemical_list: D000241:Adenosine