title: Estimation of coronary flow reserve by sestamibi imaging in patients with mild hypertension and normal coronary arteries.
abstract: OBJECTIVE
  Patients with hypertension may exhibit abnormal vasodilator capacity during pharmacological vasodilatation. We assessed coronary flow reserve (CFR) by sestamibi imaging in hypertensive patients with normal coronary vessels.
  
  
  METHODS
  Twenty-five patients with untreated mild essential hypertension and normal coronary vessels and 10 control subjects underwent dipyridamole-rest Tc-99m sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in pulmonary artery and myocardial counts from tomograhic images. CFR was expressed as the ratio of stress to rest MBF. Coronary vascular resistances (CVR) were computed as the ratio between mean arterial pressure and MBF.
  
  
  RESULTS
  Estimated MBF at rest was not different in patients and controls (1.11 ± 0.59 vs. 1.14 ± 0.28 counts/pixel/s; P=0.87). Conversely, stress MBF was lower in patients than in controls (1.55 ± 0.47 vs. 2.68 ± 0.53 counts/pixel/s; P<0.001). Thus, CFR was reduced in patients compared to controls (1.61 ± 0.58 vs. 2.43 ± 0.62; P<0.001). Rest and stress CVR values were higher in patients (P<0.001), while stress-induced changes in CVR were not different (P=0.08) between patients (-51%) and controls (-62%). In the overall study population, a significant relation between CFR and stress-induced changes in CVR was observed (r=-0.86; P<0.001).
  
  
  CONCLUSIONS
  Sestamibi imaging may detect impaired coronary vascular function in response to dipyridamole in patients with untreated mild essential hypertension and normal coronary arteries. A mild increase in arterial blood pressure does not affect baseline MBF, but impairs coronary reserve due to the amplified resting coronary resistances.
authors.affiliation: IRCCS, CROB, Rionero in Vulture, Potenza, Italy - cuocolo@unina.it.
authors.forename: G
authors.initials: G
authors.lastname: Storto
authors.forename: R
authors.initials: R
authors.lastname: Gallicchio
authors.forename: F
authors.initials: F
authors.lastname: Maddalena
authors.forename: T
authors.initials: T
authors.lastname: Pellegrino
authors.forename: M
authors.initials: M
authors.lastname: Petretta
authors.forename: G
authors.initials: G
authors.lastname: Fiumara
authors.forename: A
authors.initials: A
authors.lastname: Cuocolo
mesh_terms: D000328:Adult; D000792:Angiography; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000737:chemistry*; D012044:Regression Analysis; D012984:Software; D017256:Technetium Tc 99m Sestamibi / Q000737:chemistry*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi