Objective  To explore the situation of impaired cardiac microcirculatory perfusion, left ventricular remodeling and myocardial fibrosis in patients with essential hypertension (abbreviated as hypertension) and their clinical significance.

Methods  Eighty patients with hypertension were selected as hypertension group, and another 80 healthy individuals who underwent physical examinations during the same period were selected as control group. Based on the severity of hypertension, patients in the hypertension group were divided into low-risk group and moderate-to-high-risk group. The indicators of impaired cardiac microcirculatory perfusionleft ventricular myocardial blood flow (MBF), right ventricular MBF, coronary flowreserve (CFR), left ventricular remodeling left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and myocardial fibrosis left ventricular isovolumic relaxation time (IVRT), the ratio of the peak velocity of E wave to A wave in the diastolic blood flow spectrum of the mitral valve orifice (E/A), type Ⅰ procollagen carboxy-terminal peptide (PⅠCP), type Ⅲ procollagen amino-terminal peptide (PCⅢ)were compared between the control group and the hypertension group. Pearson′s correlation coefficient method was used for correlation analysis. The differences in the above-mentioned indicators among different risk groups were compared. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic efficacy of impaired cardiac microcirculatory perfusion, left ventricular remodeling and myocardial fibrosis for the severity of hypertension.

Results  In the hypertension group, left ventricular MBF, right ventricular MBF and CFR were all lower than those in the control group, LVEDV and LVESV were larger than those in the control group, LVEF was lower than that in the control group, IVRT was longer than that in the control group, the levels of PⅠCP and PCⅢ were higher than those in the control group, and E/A was lower than that in the control group (P < 0.05). The results of Pearson′s correlation coefficient analysis showed that LVEF was positively correlated with CFR and E/A, and negatively correlated with IVRT and PCⅢ; LVEDV was positively correlated with CFR, IVRT, PⅠCP and PCⅢ; LVESV was positively correlated with IVRT, PⅠCP and PCⅢ, and negatively correlated with E/A; left ventricular MBF was positively correlated with CFR and E/A, and negatively correlated with IVRT, PⅠCP and PCⅢ; right ventricular MBF was positively correlated with CFR and E/A, and negatively correlated with IVRT, PⅠCP and PCⅢ. In the moderate-to-high-risk group, IVRT was longer than that in the low-risk group, LVEDV was larger than that in the low-risk group, PⅠCP, PCⅢ, E/A, LVEF, left ventricular MBF, right ventricular MBF and CFR were all lower than those in the low-risk group, and LVESV was smaller than that in the low-risk group, with statistically significant differences (P < 0.05). The results of ROC curve analysis showed that the areas under the curves for diagnosing the severity of hypertension by impaired cardiac microcirculatory perfusion, left ventricular remodeling and myocardial fibrosis were 0.962, 0.969 and 0.945 respectively, the sensitivities were 91.4%, 97.1% and 88.6% respectively, and the specificities were 95.6%, 88.9% and 93.3% respectively.

Conclusion  Hypertension can cause impaired cardiac microcirculatory perfusion and promote the processes of left ventricular remodeling and myocardial fibrosis. Impaired cardiac microcirculatory perfusion, left ventricular remodeling and myocardial fibrosis have good diagnostic efficacy for the severity of hypertension.