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KMID : 0648320040100020068
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Journal of The Korean Society of Hypertension
2004 Volume.10 No. 2 p.68 ~ p.76
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Relation between Myocardial Fibrosis and Coronary Flow Reserve in Hypertensives
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Youn Ho-Joong
Ihm Sang-Hyun
Kim Ji-Hun
Park Chul-Soo
Lee Jong-Min
Oh Yong-Seog
Chung Wook-Sung
Kim Jae-Hyung
Choi Kyu-Bo
Hong Soon-Jo
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Abstract
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Background : The purpose of this study was to evaluate the relation between serum markers of myocardial fibrosis and coronary flow reserve (CFR) using transthoracic Doppler echocardiography (TTE) in patients with arterial
hypertension.
Methods : In fifty-eight subjects (M:F=31:27, mean age 57±9 years) with chest pain and normal coronary angiogram, we examined the myocardium just beneath the apical impulse window at a depth of 3 to 5cm by using TTE (6-or 7-MHz centerline frequency transducer). After obtaining linear color signals using a special preset coronary program
with a low Nyquist limit (12 to 20cm), the width, peak diastolic pulsed Doppler velocities (PDV) were measured.
PICA(penetrating intramyocardial coronary artery)-CFR was calculated as the ratio of hyperemic PDV after the
intravenous infusion of adenosine (140g/kg/min) to baseline PDV. PICA-width ratio was calculated as the ratio of
hyperemic to baseline width of color Doppler signal of PICA. Serum PIP, TGF-1, and TIMP-1 levels were measured
as serum markers of myocardial fibrosis. The subjects were divided into 3 groups: 19 hypertensives with PICA-CFR
< 2.0(group A, mean CFR=1.88±0.43), 23 hypertensives with PICA-CFR 2.0 (group B, mean CFR=2.90±0.50) and
16 normotensives with PICA-CFR 2.0(group C, mean CFR=3.09±0.70).
Results : Baseline coronary flow velocity was 28.87±16.97cm/s in group A, 16.90±5.54cm/s in group B and 14.60±4.07
cm/s in group C (p<0.005 versus group B and group C). PICA-width ratio was 1.64±0.46 in group A, 2.09±0.55
in group B and 1.93±0.47 in group C (p<0.005 versus group B and group C). Serum PIP was 131.35±31.76g/L
in group A, 107.66±26.04g/L in group B, and 90.10±22.35g/L in group C (p<0.0001 versus group B and group C). There were no significant differences in serum TGF-β and TIMP1 levels among 3 groups. A cutoff of 120g/L
for PIP provided 58% sensitivity and 74% specificity for predicting CFR<2.0 in hypertensives.
Conclusions : These results show an association between the severity of myocardial fibrosis and CFR in hypertension.
Thus, the combination of these 2 parameters, PIP and CFR, may be useful for the diagnosis of myocardial fibrosis
associated with hypertension in patients with chest pain and normal coronary angiogram.
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KEYWORD
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Hypertension, Myocardial fibrosis, Coronary flow reserve
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