Early detection of coronary artery flow and myocardial perfusion impairment in hypertensive patients evidenced by myocardial blush grade (MBG) and thrombolysis in myocardial infarction (TIMI) frame count (TFC).
OBJECTIVE
In hypertensive patients with typical chest pain but absence of coronary stenosis the coronary microcirculation may be impaired, thus, our study aimed to appraise, in these subjects, the role of the coronary microcirculation, assessed by Myocardial Blush Grade (MBG) and Thrombolysis in Myocardial Infarction (TIMI) Frame Count (TFC).


METHODS
A total of 95 subjects with chest pain and uninjured coronary arteries were recruited into the study: 80 subjects were hypertensive while 15 subjects were normotensive. The hypertensive subjects were divided into two subgroups: hypertensive subjects with positive scintigraphy and hypertensive subjects with negative scintigraphy. The TFC, a quantitative method of assessing coronary artery flow, the MBG, an assessment of the level of tissue perfusion, and the Total Myocardial Blush Score (TMBS), the sum of the myocardial blush grades of each coronary territory, were evaluated on the coronary angiogram of every patient.


RESULTS
The TFC was higher (p<0.05) in hypertensive subjects than in normotensive subjects. The MBG and the TMBS were lower (p<0.05) in hypertensive subjects than in normotensive subjects. The TFC was higher (p<0.05) in positive scintigraphy than in negative scintigraphy. The MBG was lower (p<0.05) in positive scintigraphy than in negative scintigraphy. The Spearman rank correlation test showed that the TFC and the MBG was inversely associated.


CONCLUSIONS
The hypertensive subjects had impaired coronary artery flow and myocardial perfusion, documented by the TFC, MBG and myocardial perfusion scintigraphy. These methods may be universally applicable, in fact they are validated and most catheterization laboratories have access to them.
Division and Post-Graduate School of Cardiology, Center for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for the Secondary Prevention, University Hospital "P. Giaccone" of the University of Palermo, Italy.
Salvatore
S
Evola
Francesco
F
Cuttitta
Giovanna
G
Evola
Francesca
F
Macaione
Davide
D
Piraino
Maria Cristina
MC
Meschisi
Angelica
A
Peritore
Daniela
D
Di Lisi
Guiseppina
G
Novo
Salvatore
S
Novo
D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000503:physiopathology; D002637:Chest Pain / Q000503:physiopathology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi