Relation between Coronary Blood Flow and Left Ventricular Mass in Hypertension. Noninvasive Quantification of Coronary Blood Flow by Thallium-201 Myocardial Scintigraphy.

Abstract

This study was conducted to quantify coronary blood flow (CBF) noninvasively according to the fractionation principle and to elucidate the relation between CBF and left ventricular hypertrophy. CBF/ cardiac output (CO), estimated on the basis of the ratio of myocardial uptake/total injected dose of thallium-201(% cardiac uptake), was determined in 14 control subjects and 40 patients with essential hypertension. CBF and CBF per 100 g of myocardium (unit CBF) were calculated according to the following formulas: CBF = % cardiac uptake X CO, and unit CBF = (CBF/ LVM) X 100, where CO and left ventricular mass (LVM) are echocardiographically determined. There was good reproducibility of % cardiac uptake (r= 0.983, p < 0.0001). Percent cardiac uptake was greater in hypertensive patients (4.65 ± 1.44%) than in control subjects (3.64± 0.64%), and there was a positive correlation between % cardiac uptake and LVM. CBF (ml/ min) was greater in hypertensive patients (240.7 ± 80.5) than in control subjects (194.9 + 36.9), but unit CBF (ml/min/ 100 g) was less in hypertensive patients (102.2 ± 26.7) than in control subjects (150.3 ± 30.5). Multiple regression analyses showed that LVM was the most potent independent predictor of resting CBF in hypertension. Our results indicate that CBF, determined by thallium-201 myocardial scintigraphy, increases parallel to the increase in LVM, but unit CBF decreases even in the resting condition in patients with essential hypertension. (Hypertens Res 1998; 21: 227-234) Key Words: coronary blood flow, thallium-201 myocardial scintigraphy, left ventricular mass, left ventricular hypertrophy, essential hypertension Left ventricular hypertrophy associated with hypertension is not only a physiological adaptation to sustained arterial hypertension, but also a pathologic process leading to heart failure (1, 2). In addition, left ventricular mass is an independent risk factor for cardiovascular diseases (3, 4), and increased left ventricular mass predicts increased cardiovascular morbidity and mortality (4, 5). However, why left ventricular hypertrophy predisposes patients to morbid events is not fully understood. Many studies have shown that coronary blood flow (CBF) reserve is reduced in hypertensive patients with left ventricular hypertrophy (6-13). Thus, changes in the coronary circulation associated with left ventricular hypertrophy seem to be related to cardiovascular morbidity and mortality. However, only a few studies have quantified CBF in patients with hypertension (6, 7, 12) because of the complexity and invasiveness of conventional techniques for measurement of CBF. CBF can be determined noninvasively by positron-emission tomography with nitrogen-13-ammonia (14), but this method is not in general use. Very recently, Kazakova et al. (13) determined the coronary flow reserve by transesophageal Doppler echocardiography. This method, however, measures only flow velocity and not absolute volumetric flow.Sapirstein (15) first indicated that the fractional distribution of K-42 or Rb-86 co...

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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

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Myocardial interstitial glucose and lactate before, during, and after cardioplegic heart arrest

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