Vol 11, No 3 (2007)
Editorial
Published online: 2007-05-31
Dysfunction of coronary microcirculation in hypertension
Kalina Kawecka-Jaszcz, Agnieszka Olszanecka, Artur Klecha
Nadciśnienie tętnicze 2007;11(3):179-186.
Vol 11, No 3 (2007)
Artykuły redakcyjne
Published online: 2007-05-31
Abstract
Arterial hypertension and its complications seem to be one
of the most important current health problems. The heart
is particularly exposed for the harmful influence of the
chronically elevated blood pressure. Coronary atherosclerosis
leading to ischaemic heart disease and myocardial
infarction as well as left ventricular hypertrophy and heart
failure are frequent consequences of arterial hypertension.
However, in 15–20% of patients with hypertension and
diagnosed ischaemic heart disease coronary angiography
does not show any changes in coronary vessels. It is postulated
that in this group of patients, myocardial perfusion
defects resulted from coronary microcirculation disturbances
are responsible for ischaemia. Vascular remodeling
increases coronary resistance since it is associated with decrease
in arteriolar lumen and eventually leads to the reduction
of the density of arterioles and capillaries in the
vascular bed (structural rarefaction) A second mechanism
of hypertension causing myocardial ischaemia is related to
left ventricular hypertrophy. Hypertrophied cardiomyocytes
compressing coronary vessels decrease their
vasodilating capacity. Increased left ventricular wall strain
in arterial hypertension may also be involved in the process
of impaired coronary reserve.
There are several methods for coronary microcirculation
assessment. Coronary flow reserve measurement during angiography
is the invasive one. Among non invasive methods
of coronary flow measurements echocardiographic techniques
(both transesophageal and transthoracic), nuclear
medicine techniques, positron emission tomography and
cardiac magnetic resonance imaging should be mentioned. This article is a review of currently available methods for
coronary microcirculation assessment. In the paper the results
of different studies on myocardial perfusion in arterial
hypertension are discussed. The article also brings up the
problem of clinical meaning of disturbances in coronary microcirculation
and possible therapeutic interventions by antihypertensive
therapy improving coronary reserve.
Abstract
Arterial hypertension and its complications seem to be one
of the most important current health problems. The heart
is particularly exposed for the harmful influence of the
chronically elevated blood pressure. Coronary atherosclerosis
leading to ischaemic heart disease and myocardial
infarction as well as left ventricular hypertrophy and heart
failure are frequent consequences of arterial hypertension.
However, in 15–20% of patients with hypertension and
diagnosed ischaemic heart disease coronary angiography
does not show any changes in coronary vessels. It is postulated
that in this group of patients, myocardial perfusion
defects resulted from coronary microcirculation disturbances
are responsible for ischaemia. Vascular remodeling
increases coronary resistance since it is associated with decrease
in arteriolar lumen and eventually leads to the reduction
of the density of arterioles and capillaries in the
vascular bed (structural rarefaction) A second mechanism
of hypertension causing myocardial ischaemia is related to
left ventricular hypertrophy. Hypertrophied cardiomyocytes
compressing coronary vessels decrease their
vasodilating capacity. Increased left ventricular wall strain
in arterial hypertension may also be involved in the process
of impaired coronary reserve.
There are several methods for coronary microcirculation
assessment. Coronary flow reserve measurement during angiography
is the invasive one. Among non invasive methods
of coronary flow measurements echocardiographic techniques
(both transesophageal and transthoracic), nuclear
medicine techniques, positron emission tomography and
cardiac magnetic resonance imaging should be mentioned. This article is a review of currently available methods for
coronary microcirculation assessment. In the paper the results
of different studies on myocardial perfusion in arterial
hypertension are discussed. The article also brings up the
problem of clinical meaning of disturbances in coronary microcirculation
and possible therapeutic interventions by antihypertensive
therapy improving coronary reserve.
Keywords
coronary microcirculation; hypertension; small vessel disease; coronary flow reserve
Title
Dysfunction of coronary microcirculation in hypertension
Journal
Arterial Hypertension
Issue
Vol 11, No 3 (2007)
Article type
Editorial
Pages
179-186
Published online
2007-05-31
Page views
1329
Article views/downloads
2138
Bibliographic record
Nadciśnienie tętnicze 2007;11(3):179-186.
Keywords
coronary microcirculation
hypertension
small vessel disease
coronary flow reserve
Authors
Kalina Kawecka-Jaszcz
Agnieszka Olszanecka
Artur Klecha