Circulation, Vol 88, 993-1003, Copyright © 1993 by American Heart Association
B Schwartzkopff, W Motz, H Frenzel, M Vogt, S Knauer and BE Strauer
BACKGROUND. In hypertensive patients with angina pectoris, the coronary
vasodilator reserve is frequently impaired despite a normal coronary
angiogram. Experimental data indicate that structural alterations of the
intramyocardial coronary vasculature contribute to an increased minimal
coronary resistance and a diminished coronary flow reserve. METHODS AND
RESULTS. In 14 patients (10 men and 4 women) with arterial hypertension and
8 normotensive subjects, minimal coronary resistance and vasodilator
reserve (dipyridamole: 0.5 mg/kg body wt, gas chromatographic argon method)
were determined after the angiographic exclusion of relevant coronary
artery disease. Coronary reserve was depressed in hypertensive patients
(2.7 +/- 2.3 vs 4.6 +/- 1.3, P < or = .05) due to increased minimal
coronary resistance (0.64 +/- 30 vs 0.24 +/- 0.055 mm Hg.min.100 g.mL-1, p
< or = 0.002). In right septal biopsies, mean external arteriolar
diameter (21.6 +/- 2.3 vs 17.2 +/- 2.5 microns, P < or = .001), mean
arteriolar wall area (271 +/- 61 vs 172 +/- 62 microns 2, P < or = .01),
percent medial wall area (69.9 +/- 4.0 vs 66.0 +/- 3.2%W, P < or = .05),
mean periarteriolar fibrosis area (216 +/- 122 vs 104 +/- 68 microns 2, P
< or = .05), and volume density of total interstitial fibrosis (3.6 +/-
1.8 vs 1.9 +/- 0.5Vv% fibrosis, P < or = .05) were increased in
hypertensive patients compared with normotensive subjects. Minimal coronary
resistance correlated with %W (r = .6, P < or = .003) and Vv% fibrosis
(r = .62, P < or = .002). Left ventricular mass index (111 +/- 21 vs 97
+/- 17 g/m2, P = NS) and left ventricular end-diastolic pressure (12 +/- 6
vs 8 +/- 3 mm Hg, P = NS) did not correlate significantly with minimal
coronary resistance. In multivariate analysis, both %W and Vv% fibrosis
explained half of the variability of minimal coronary resistance (r2 = .5,
P < or = .002). CONCLUSIONS. Structural remodeling of the
intramyocardial coronary arterioles and the accumulation of fibrillar
collagen are decisive factors for a reduced coronary dilatory capacity in
patients with arterial hypertension and angina pectoris in the absence of
relevant coronary artery stenoses.
ARTICLES
Structural and functional alterations of the intramyocardial coronary arterioles in patients with arterial hypertension
Department of Medicine, Heinrich-Heine University of Dusseldorf, FRG.
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