Διαστολική δυσλειτουργία αριστερής κοιλίας και στεφανιαία εφεδρεία ; Left ventricular diastolic dysfunction and coronary flow reserve

Arterial hypertension (AH) is a major risk factor for cardiovascular disease and is associated with functional and structural changes in the heart and the vasculature. AH promotes myocardial hypertrophy, cardiomyocyte apoptosis and myocardial fibrosis through various pathways. These alterations may lead to impaired diastolic filling and systolic contraction of the left ventricle (LV) associated with clinical or subclinical cardiac dysfunction. AH also affects the peripheral vasculature causing arterial endothelial dysfunction, increased progression of interstitial and perivascular fibrosis vascular remodeling and reduction in the number of small arterioles (i.e. microangiopathy) . Coronary microcirculation may be damaged either directly from vascular changes or through the elevation of the LV diastolic pressure causing increased extravascular compression leading to impaired coronary flow reserve (CFR). Previous clinical studies have shown that impaired CFR may lead to exercise induced myocardial ischaemia and to exercise-induced LV diastolic and systolic dysfunction in patients with AH. The aim of the current study was to investigate whether early (relatively healthy) hypertensive patients with normal LV ejection fraction may differ in 2D Strain indices (2DSTE) at baseline and in response to a stress test such as dipyridamole,(DIPSE) compared to healthy controls. In the current study, the associations of 2DSTE indices and their changes following DIPSE with other studied parameters were also assessed.Forty-seven male hypertensive patients (aged 57±9 years) with normal ejection fraction and without left ventricular (LV) hypertrophy and 20 healthy male subjects were studied with conventional and 2DSTE echocardiography at rest and post DIPSE. Coronary flow reserve (CFR) in the left anterior descending artery following DIPSE was also evaluated. Global longitudinal strain (GLS) and TWIST were higher while UNTWIST rate was lower in hypertensives versus controls (p < 0.05 for all); TWIST remained higher in ...