Coronary Hemodynamics in Hypertensive Heart Disease

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Abstract
Myocardial hypertrophy may influence coronary hemodynamics variably. Therefore, coronary blood flow (CBF) (gas chromatic argon technique) was determined in patients with left ventricular (LV) hypertrophy, with or without dilatation, associated with exclusively normal coronary arteriogram: 12 patients with hypertrophic obstructive cardiomyopathy (HOC) (LV mass to volume (M/V) ratio: 3.66 + 0.52 g/ml), 22 patients with hypertensive heart disease due to essential hypertension (EH) (LV M/V ratio: 2.12 + 0.26 g/ml), 18 patients with hypertensive dilatation (M/V ratio: 1.6 + 0.48 g/ml), 6 patients with aortic stenosis (LV M/V ratio: 1.99 + 0.41 g/ml), 12 patients with aortic incompetence (AI), 20 patients with normal heart function. CBF was determined as (A) controls and (B) following the intravenous injection of dipyridamole (0.5 mg/kg body weight). Coronary reserve (CR) was calculated as the ratio of coronary resistance before and after dipyridamole. Normal CR averaged 4.89 + 0.11 similar values despite marked LV hypertrophy, were present for both HOC (4.4 + 0.19) and as (4.66 + 0.12), whereas CR was considerably reduced in the concentrically hypertrophied hypertensive hearts (3.22 + 0.19) (p less than 0.001). Moderate decrease of CR was found in AI and in dilated EH. The results indicate that nonhypertensive hypertrophy, despite LV mass augmentation, may have normal CR, whereas at a comparable degree of LV hypertrophy, hypertensive hypertrophy has specific reduction in CR. Independent from vascular effects, ventricular dilatation may deteriorate CR because of an abnormal component of coronary vascular resistance.

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