Coronary Circulation in Patients with Pressure-Overloaded Left Ventricular Hypertrophy

Abstract

Pressure-overloaded left ventricular hypertrophy is the major risk factor causing adverse cardiovascular events, including myocardial ischemia and heart failure. The aim of this study was to investigate the characteristics of phasic blood flow pattern in patients with pressure-overloaded left ventricular (LV) hypertrophy, i. e., hypertension and pure aortic valve stenosis. Coronary blood flow velocity measurements were performed by a 20-MHz Doppler catheter or by a 20-MHz 80-channel Doppler velocimeter. The coronary circulation of pressure-overloaded LV hypertrophy was characterized by (1) enhanced systolic retrograde flow, (2) delayed early diastolic coronary inflow, and (3) increased blood flow in mid-to-late diastole. The vascular and perivascular histological changes with increased systolic vascular compression and impaired LV relaxation may affect the phasic coronary flow pattern, i. e., increased systolic retrograde flow and delayed early diastolic inflow. These flow changes may result in decreased coronary flow reserve and subendomyocardial ischemia in the patients with pressure-overloaded left ventricular hypertrophy.