Reduced Antegrade Flow in the Coronary Sinus Is a Predictor of Coronary Artery Stenosis in Hypertensive Patients

Abstract

The purpose of this study was to evaluate the feasibility of assessing blood flow in the coronary sinus by transthoracic Doppler echocardiography for detecting coronary artery stenosis in hypertensive patients. Flow in the coronary sinus was studied in 105 participants who all had undergone coronary angiography: 35 nonhypertensive patients, 34 hypertensive patients without coronary artery disease (CAD), and 36 hypertensive patients with CAD. The antegrade phase of flow in the coronary sinus was analyzed and compared among the groups. Multivariate analysis for blood flow and coronary artery stenosis was done. Compared with the nonhypertensive patients, the hypertensive patients without CAD had significantly higher blood flow (9.36 ± 5.94 vs 5.84 ± 2.91 mL/stroke and 584.45 ± 177.32 vs 327.68 ± 125.48 mL/min, respectively; P < .001) in the coronary sinus. Compared with the hypertensive patients without CAD, those with CAD had significantly lower blood flow (5.18 ± 0.72 vs 9.36 ± 5.94 mL/stroke and 352.51 ± 156.18 vs 584.45 ± 177.32 mL/min; P < .001) and a lower velocity time integral (13.14 ± 2.51 vs 19.85 ± 4.89 cm; P < .01). Stepwise multiple regression analysis indicated that the coronary sinus diameter, velocity time integral, and heart rate significantly correlated with the blood flow per minute in the coronary sinus in each group, and the flow per minute was the independent determinant of the percent stenosis diameter. The sensitivity, specificity, and accuracy for the prediction of severe stenosis (>70%) in the left coronary artery were 91.07%, 87.76%, and 88.49% for blood flow of less than 220 mL/min in the coronary sinus. Transthoracic Doppler echocardiography can effectively depict blood flow changes in the coronary sinus, and reduced antegrade flow is a sensitive and specific predictor of coronary artery stenosis in hypertensive patients.