Coronary blood flow in left ventricular hypertrophy: a review of experimental data

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Abstract
Ischemia is a potential complication of left ventricular hypertrophy (LVH). Under resting conditions, coronary blood flow (CBF) per unit mass and its transmural distribution are usually normal and reflect total or regional myocardial oxygen needs. Studies of the coronary circulation after stimulation by pharmacological means, pacing or excercise have revealed a wide spectrum of results from a normal increase in flow (coronary flow reserve) in some cases to a significant reduction in others with altered transmural distribution and decreased ratio of endo/epicardial flow. These results suggest that subendocardial ischemia may occur in experimental LVH. They are consistent with clinical observations of angina pectoris or ECG abnormalities in patients with LVH and no detectable coronary artery lesions. Much remains to be learned regarding changes in CBF with reversal of LVH. With regard to this problem, we found that the relation of myocardial mass to the driving head of pressure for the coronary circulation, i.e. the aortic pressure, plays a highly significant role. If aortic pressure and myocardial hypertrophy vary in parallel, little disturbance is expected in maximal coronary flow but if hypertrophy exists or persists in the presence of a relatively low aortic pressure, coronary reserve could be reduced. Thus, antihypertensive drugs that lower blood pressure but not LV mass may have adverse effects on the coronary flow reserve although blood pressure returns to normal.

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