Mahfouz Ragab A, Dwidar Ashraf Elsaied, El Tahlawi Mohammad A
Department of Cardiology, Zagazig University, Zagazig, Egypt.
Echocardiography. 2011 Nov;28(10):1113-8. doi: 10.1111/j.1540-8175.2011.01484.x. Epub 2011 Aug 19.
Although coronary flow reserve (CFR) is reduced in hypertensive patients, data regarding the endothelial response of coronary vasomotion and its relation to left ventricular (LV) function in their offspring is limited.
To investigate the endothelial response of coronary flow, using cold pressor test (CPT), in offspring of hypertensive parents and its impact on LV diastolic function.
The study population consisted of 32 healthy young offspring (mean age 23.5 ± 7.1 years) of hypertensive parents and 26 aged matched volunteers (healthy offspring of normotensive parents) as controls. Coronary blood flow velocities were recorded in all subjects at rest and after CPT; a stimulus that can be considered totally endothelium-dependent. CFR was calculated as the ratio of hyperemic-to-resting diastolic peak velocities. Doppler echocardiographic assessment was performed using both conventional and tissue Doppler assessment.
Coronary diastolic peak velocities at rest was comparable between the two groups (27.1 ± 6.2 vs 26.4 ± 5.8; P > 0.05); but the velocities were significantly lower after CPT in offspring of hypertensive parents (P < 0.02), with highly significant lower CFR (P < 0.0001). Conventional echo-Doppler variables were comparable in both groups, whereas tissue Doppler assessment demonstrated significant LV diastolic dysfunction among offspring of hypertensive parents. The CPT-CFR was significantly correlated to tissue Doppler diastolic dysfunction in this group (For Em, Am and Em/Am, r was 0.65, 0.59 and 0.61, respectively, and P < 0.001).
Offspring of hypertensive parents have coronary endothelial dysfunction that appears in response to physiological stimuli (CPT). The coronary endothelial dysfunction is associated with latent LV diastolic dysfunction.
尽管高血压患者的冠状动脉血流储备（CFR）降低，但关于其后代冠状动脉血管运动的内皮反应及其与左心室（LV）功能的关系的数据有限。
使用冷加压试验（CPT）研究高血压父母后代的冠状动脉血流内皮反应及其对左心室舒张功能的影响。
研究人群包括32名高血压父母的健康年轻后代（平均年龄23.5±7.1岁）和26名年龄匹配的志愿者（血压正常父母的健康后代）作为对照。记录所有受试者静息时和CPT后的冠状动脉血流速度；CPT是一种可被视为完全依赖内皮的刺激。CFR计算为充血期与静息期舒张期峰值速度之比。使用传统和组织多普勒评估进行多普勒超声心动图评估。
两组静息时的冠状动脉舒张期峰值速度相当（27.1±6.2对26.4±5.8；P>0.05）；但高血压父母后代在CPT后的速度显著降低（P<0.02），CFR显著降低（P<0.0001）。两组的传统超声多普勒变量相当，而组织多普勒评估显示高血压父母后代存在明显的左心室舒张功能障碍。该组中CPT-CFR与组织多普勒舒张功能障碍显著相关（对于Em、Am和Em/Am，r分别为0.65、0.59和0.61，P<0.001）。
高血压父母的后代存在冠状动脉内皮功能障碍，这在对生理刺激（CPT）的反应中表现出来。冠状动脉内皮功能障碍与潜在的左心室舒张功能障碍有关。
