Simultaneous echocardiographic evaluation of coronary flow velocity reserve and aortic distensibility indices in hypertension

Abstract

The coronary flow velocity reserve (CFVR), a measure of endothelial function in coronary circulation, can be measured semi-invasively in the left anterior descending coronary artery by using stress transesophageal echocardiography (TEE). During the same stress TEE, aortic distensibility indices (elastic modulus [E(p)] and Young's circumferential static elastic modulus [E(s)]) can be assessed. The purpose of the present study was to examine whether stress TEE is valuable method for parallel evaluation of CFVR, E(p), and E(s) in patients with hypertension. A total of 38 patients with chest pain but with a negative coronary angiogram were enrolled into the present study, which included examination of the presence or absence of hypertension. Significant coronary stenosis was considered present in the event of a luminal diameter reduction of >50% on use of the "worst view method." Patients with significant coronary or valvular heart disease, atrial fibrillation, heart failure, unstable angina pectoris, acute myocardial infarction, or diabetes mellitus were excluded from the study. Stress TEE was performed in each case to evaluate CFVR, E(p), and E(s). Coronary flow velocity reserve and diastolic coronary flow velocities measured at peak stress were decreased in hypertensive patients as compared with normotensive subjects. E(p) and E(s) were significantly increased in hypertensive patients. In conclusion, it can be stated that Stress TEE is a useful tool for the simultaneous evaluation of the CFVR, E(p), and E(s) in hypertension. The CFVR and aortic distensibility are decreased in hypertension.