Different Coronary Blood Flow Increase in Left Ventricular Hypertrophy Due to Hypertension Compared to Hypertrophic Cardiomyopathy at Elevated Heart Rate

Takechi, Shigeru; Nomura, Akio; Machida, Maiko; Fujimoto, Tetsuya; Kakinoki, Shigeo; Komuro, Kaoru; Kitabatake, Akira

doi:10.1291/hypres.26.789

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…Total CBF in systemic arterial HTN was consistently found to be increased in studies using different methodologies to measure total CBF . Doppler assessment of blood flow in the LAD also showed an increased CBF in patients with HTN . Once the data were adjusted for LV mass, however, there was a significant reduction in CBF, a finding evident in the meta‐analysis.…”

Section: Discussionmentioning

confidence: 73%

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Differences in Coronary Blood Flow in Aortic Regurgitation and Systemic Arterial Hypertension Have Implications for Diastolic Blood Pressure Targets: A Systematic Review and Meta‐Analysis

Rabkin

2013

Clinical Cardiology

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The objective was to evaluate coronary blood flow (CBF) in patients with systemic arterial hypertension (HTN) and to compare it with CBF in patients with aortic regurgitation (AR). A systematic literature search was conducted using the reference terms ''coronary blood flow'' and either ''aortic regurgitation'' or ''hypertension.'' The selection criteria included CBF measurement in a concomitant control group, except studies evaluating CBF with aortic-valve replacement surgery. Twenty-two studies met the inclusion criteria. There were 318 persons with HTN, with 185 controls; and 102 persons with AR, with 144 controls. Despite an overall increase in CBF in HTN, CBF per gram of left ventricular mass was significantly (P < 0.0001) reduced. In contrast, CBF per gram of left ventricular mass was significantly (P = 0.004) increased in AR. Aortic regurgitation was associated with a significant (P < 0.0001) increase in CBF during systole and away from diastole, in contrast to persons with HTN. Aortic-valve replacement reversed the increase in systolic CBF. These data suggest that patients with HTN are more vulnerable than patients with AR to lower diastolic blood pressure (DBP), because resting CBF is compromised in HTN. Furthermore, patients with HTN may not compensate for DBP reductions by shifting CBF to systole, such as can occur with the low DBP in AR. Lower DBP in patients with AR cannot be used to justify treating patients with HTN to similar DBP because of the dramatic differences in CBF between the 2 conditions.

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Section: Discussionmentioning

confidence: 73%

“…Eleven studies were identified and comprised the review of the effect of HTN on CBF in patients (Table ). Seven studies measured total blood flow and 4 measured flow in the left anterior descending coronary artery (LAD) . There were 318 persons with HTN and 185 controls.…”

Section: Resultsmentioning

confidence: 99%

Differences in Coronary Blood Flow in Aortic Regurgitation and Systemic Arterial Hypertension Have Implications for Diastolic Blood Pressure Targets: A Systematic Review and Meta‐Analysis

Rabkin

2013

Clinical Cardiology

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“…A population of middle-aged to older males with HTN inevitably has a relatively high incidence of underlying CAD. The fact that endothelial function is so often abnormal in HTN patients (46,47) attests to the likelihood that sub-clinical CAD is common and may be the rule. Thus, while it certainly would be of great interest to perform similar measurements in a cohort without CAD, we believe that age and sex-matched control and HTN/concentric remodeling groups with a common background of CAD constitute a “real world” patient cohort that is also quite representative of those at risk for the development of HFpEF.…”

Section: Discussionmentioning

confidence: 99%

Myosin Cross-Bridge Dynamics in Patients With Hypertension and Concentric Left Ventricular Remodeling

Donaldson

Palmer

Zile

et al. 2012

Circ: Heart Failure

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Background Hypertension (HTN) causes concentric left ventricular (LV) remodeling, defined as an increased relative wall thickness or overt LV hypertrophy, and associated diastolic dysfunction. HTN and concentric remodeling are also common precursors to heart failure with a preserved ejection fraction (EF). It is not known if the myofilament contributes to diastolic dysfunction in patients with concentric remodeling. Methods and Results Intra-operative myocardial biopsies were obtained in 15 male patients undergoing coronary bypass grafting (CBG), all with normal LV EF and wall motion. Eight patients had a history of HTN and concentric remodeling. Seven without HTN or remodeling served as controls. Myocardial strips were dissected and demembranated with detergent. Isometric tension was measured and sinusoidal length perturbation analysis performed at sarcomere length 2.2μm and pCa 8 –4.5. Sinusoidal analysis provides estimates of cross-bridge dynamics, including rate constants of attachment and detachment and cross-bridge attachment time (ton). The normalized isometric tension-pCa relation was similar in HTN and controls. However, ton was significantly prolonged at submaximal [Ca2+] (pCa ≥ 6.5) in HTN patients. Analysis of protein phosphorylation revealed ~25% reduction in phosphorylation of troponin I in HTN patients (P < 0.05). Conclusions Compared with controls, patients with HTN and concentric remodeling display prolonged ton at submaximal [Ca2+] without a change in the tension-pCa relation. Prolonged ton implicates altered cross-bridge dynamics as a cause of slowed relaxation in these patients. This finding was associated with reduced phosphorylation of troponin I, suggesting decreased phosphorylation of protein kinase A/G sites as a mechanism.

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“…In each of the studies, mean CBF was increased in those with hypertension. The absolute value of CBF varied because some studies measured total myocardial blood flow [ 11 , 12 ] while others measured CBF in a single coronary artery [ 13 - 16 ]. In addition, techniques for CBF measurement varied widely.…”

Section: Resultsmentioning

confidence: 99%

Considerations in Understanding the Coronary Blood Flow- Left Ventricular Mass Relationship in Patients with Hypertension

Rabkin

2016

CCR

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Background: Coronary blood flow (CBF) is essential for optimal cardiac performance and to maintain myocardial viability. There is considerable ambiguity concerning CBF in hypertension.Objective: To investigate the relationship between CBF and left ventricular (LV) mass in persons with hypertension.Methods: OvidSP Medline was systematically searched. Eligible articles assessed CBF, and LV mass in adults with and without hypertension (HTN).Results: Eleven studies met the entry criteria. All 8 studies reported an increase in CBF (ml/min) for persons with hypertension (N=212) compared to individuals without hypertension (N=150). Meta-analysis showed a significant and 2.88 fold higher CBP in hypertension. Six studies adjusted CBF for LV mass; of which 4 studies reported a reduction in CBF. Meta-analysis showed a significant decrease in CBF/g LV mass in hypertension. The two studies that did not show a decrease in CBF, used the argon chromatographic method to measure coronary sinus blood flow suggesting this methodology may have influenced the results. Using the mean CBF in normotensive group to construct the expected CBF according to LV mass, reported CBF in HTN was progressively less than expected In two studies, (N=142), there was a significant inverse correlation between LV mass and CBF/ g LV mass. Multivariate analysis (three studies) consistently found a highly significant independent relationship between LV mass and CBF after considering age, sex, heart rate and several other factors.Conclusion: Hypertension is associated with a reduction in CBF adjusted for LV mass with a highly significant inverse association between CBF and LV mass. Clinicians should be aware that patients with hypertension are at greater risk for myocardial ischemia should develop other factors that limit CBF or myocardial oxygen delivery.

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Different Coronary Blood Flow Increase in Left Ventricular Hypertrophy Due to Hypertension Compared to Hypertrophic Cardiomyopathy at Elevated Heart Rate

Cited by 6 publications

References 30 publications

Differences in Coronary Blood Flow in Aortic Regurgitation and Systemic Arterial Hypertension Have Implications for Diastolic Blood Pressure Targets: A Systematic Review and Meta‐Analysis

Differences in Coronary Blood Flow in Aortic Regurgitation and Systemic Arterial Hypertension Have Implications for Diastolic Blood Pressure Targets: A Systematic Review and Meta‐Analysis

Myosin Cross-Bridge Dynamics in Patients With Hypertension and Concentric Left Ventricular Remodeling

Considerations in Understanding the Coronary Blood Flow- Left Ventricular Mass Relationship in Patients with Hypertension

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