Evaluation of coronary blood flow reserve by13N-NH3 positron emission computed tomography (PET) with dipyridamole in the treatment of hypertension with the ACE inhibitor (Cilazapril)

Abstract

These results indicate that hypertensive patients at the early stage show decreased coronary flow reserve despite having normal resting flow. Treatment with an ACE inhibitor (Cilazapril) for 12 weeks improved coronary flow reserve in 42% of our patients. The CVR of the patients with CFR < 2.0 showed improvement compared to those with CFR> or = 2.0. This result indicates that an ACE inhibitor (e.g., Cilazapril) should be one of the choices for improving CFR if hypertensive patients in early stage show signs of ischemia or diastolic dysfunction, which may be one of the sequels of reserve restriction.

Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography

“…Cardiac PET imaging is the noninvasive gold standard for obtaining quantitative regional blood flows and CFR. [20][21][22] However, the high cost and complexity of PET have limited its use in routine clinical assessment.…”

Nuclear Cardiac Stress Testing in the Era of Molecular Medicine

“…Reduced resting coronary flow and impaired increase in flow as a response to pharmacologic or cold pressor ''stress'' serve as markers of endothelial dysfunction. Impaired myocardial blood flow or flow reserve has been demonstrated in asymptomatic patients with elevated cholesterol (58), smoking (59), hypertension (60), and insulin resistance (61). In patients with single-vessel CAD undergoing flow-pressure measurements, flow resistance and fractional flow reserve were shown to be abnormal in .50% of presumably normal vessels (62).…”

Detection of perfusion abnormalities on coronary angiograms in hypertension by myocardium selective densitometric perfusion assessments

“…Several sophisticated methods are available to assess reserve capacity of coronary circulation and myocardial perfusion including videodensitometric analysis on coronary angiograms [2][3][4][5][6]. The present study was aimed to evaluate regional myocardial perfusion abnormalities by a novel computerized videodensitometric method in patients with arterial hypertension and negative coronary angiograms.…”

“…Several methods have been demonstrated to be feasible to detect coronary circulation and perfusion abnormalities including echocardiography [2,3], scintigraphy [4], magnetic resonance imaging [5] and positron emission tomography [6]. It would be optimal to find a tool with which coronary perfusion or microvasculature could be assessed during invasive procedures at the same time in patients with normal epicardial coronary arteries.…”

“…Moreover, several lines of evidence have suggested that high calcium intake protects against vascular disease by lowering serum cholesterol level [4] and blood pressure [5,6]. In observational studies, women with higher calcium intake had a lower risk for deaths from cardiovascular events or for ischemic stroke than women with lower calcium intake [7].…”