Assessment of intravascular and extravascular mechanisms of myocardial perfusion abnormalities in obstructive hypertrophic cardiomyopathy by myocardial contrast echocardiography

Soliman, Osama Ibrahim Ibrahim; Knaapen, Paul; Geleijnse, Marcel L.; Dijkmans, Pieter A.; Anwar, Ashraf M.; Nemes, Attila; Michels, Michelle; Vletter, Wim B.; Lammertsma, Adriaan A.; Cate, Folkert J. ten

doi:10.1136/hrt.2006.110460

Cited by 40 publications

(38 citation statements)

References 37 publications

(48 reference statements)

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“…All examinations were performed on the same day, except for the invasive measurements, which were performed within 2 wk of the other tests. The PET and echocardiographic measurements of two obstructive HCM patients have been previously reported by Soliman et al (24) in a comparative study of perfusion PET vs. contrast echocardiography.…”

Section: Study Populationmentioning

confidence: 95%

“…Indeed, selective impairment of subendocardial perfusion during pharmacologically induced impairment of hyperemia has been demonstrated in the septum of patients with HCM (10). Knowledge of the relative contribution of extravascular resistance to total microvascular dysfunction in HCM, however, is scarce (7,24). The latter is related to difficulties in simultaneous assessment of hemodynamic load and transmural perfusion distribution in absolute terms.…”

mentioning

confidence: 96%

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Determinants of coronary microvascular dysfunction in symptomatic hypertrophic cardiomyopathy

Knaapen¹,

Germans²,

Camici³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

108

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Impaired hyperemic myocardial blood flow (MBF) in hypertrophic cardiomyopathy (HCM), despite normal epicardial coronary arteries, results in microvascular dysfunction. The aim of the present study was to determine the relative contribution of extravascular compressive forces to microvascular dysfunction in HCM. Eighteen patients with symptomatic HCM and normal coronary arteries and 10 age-matched healthy volunteers were studied with PET to quantify resting and hyperemic MBF at a subendocardial and subepicardial level. In HCM patients, MRI was performed to determine left ventricular (LV) mass index (LVMI) and volumes, echocardiography to assess diastolic perfusion time, heart catheterization to measure LV outflow tract gradient (LVOTG) and LV pressures, and serum NH(2)-terminal pro-brain natriuretic peptide (NT-proBNP) as a biochemical marker of LV wall stress. Hyperemic MBF was blunted in HCM vs. controls (2.26 +/- 0.97 vs. 2.93 +/- 0.64 ml min(-1) g(-1), P < 0.05). In contrast to controls (1.38 +/- 0.15 to 1.25 +/- 0.19, P = not significant), the endocardial-to-epicardial MBF ratio decreased significantly in HCM during hyperemia (1.20 +/- 0.11 to 0.88 +/- 0.18, P < 0.01). This pattern was similar for hypertrophied septum and lateral wall. Hyperemic MBF was inversely correlated with LVOTG, NT-proBNP, left atrial volume index, and LVMI (all P < 0.01). Multivariate regression analysis, however, revealed that only LVMI and NT-proBNP were independently related to hyperemic MBF, with greater impact at the subendocardial myocardial layer. Hyperemic MBF is more severely impaired at the subendocardial level in HCM patients. The level of impairment is related to markers of increased hemodynamic LV loading conditions and LV mass. These observations suggest that, in addition to reduced capillary density caused by hypertrophy, extravascular compressive forces contribute to microvascular dysfunction in HCM patients.

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Section: Study Populationmentioning

confidence: 95%

mentioning

confidence: 96%

Determinants of coronary microvascular dysfunction in symptomatic hypertrophic cardiomyopathy

Knaapen¹,

Germans²,

Camici³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

108

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“…A few studies have looked at this relation in vivo in the past but had conflicting results (3,(16)(17)(18). In agreement with our findings, Cecchi et al (3), using 13 N-NH 3 , followed 51 HCM subjects with a baseline mean peak MBF (1.50 6 0.69 mL/min/g) and MFR (1.84 6 0.67) comparable to our study results (1.79 6 0.43 mL/min/g and 1.95 6 0.50, respectively) and found no significant difference in peak MBF between patients with LVOT obstruction (n 5 8/51, peak LVOTG $ 30 mm Hg) and those without obstruction (n 5 43/51).…”

Section: Discussionmentioning

confidence: 99%

PET/CT Assessment of Symptomatic Individuals with Obstructive and Nonobstructive Hypertrophic Cardiomyopathy

Bravo¹,

Pinheiro²,

Higuchi³

et al. 2012

J Nucl Med

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“…4 In this study, we used a method to determine MCEderived MBF in absolute units of blood volume per time in relation to myocardial mass (ml/min/g) which has been recently developed by Vogel and colleagues. 10 Absolute MBF has been validated against PET and quantitative coronary angiography in various patient populations 10,11,[22][23][24] and has also been shown to be a reproducible method. 11,22 Using an animal model of diabetes, Cosyns and colleagues reported lower perfusion rates with diabetes compared to controls.…”

Section: Discussionmentioning

confidence: 99%

Detection of myocardial microvascular disease using contrast echocardiography during adenosine stress in type 2 diabetes mellitus: Prospective comparison with single-photon emission computed tomography

Abdelmoneim

Basu

Bernier

et al. 2011

Diabetes and Vascular Disease Research

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Purrpose: To evaluate myocardial microvascular disease in patients with type 2 diabetes mellitus (DM) using myocardial contrast echocardiography (MCE) and to report on its diagnostic accuracy using single photon emission tomography (SPECT) as reference test. Methods: We prospectively enrolled 79 patients (25 DM; 66±11 years) who underwent simultaneous SPECT and MCE with contrast agent during adenosine stress. MCE and SPECT were visually analyzed using 17 segments. Quantitative MCE parameters were derived from replenishment curves. Microbubble velocity (β min -1 ), absolute myocardial blood flow (MBF ml/min/g), and reserve values were calculated. Diagnostic accuracy and area under curve (AUC) was reported. Results: Patients with DM had higher BMI vs non DM (33±7 vs 28±5kg/m 2 P=0 .007), with more prior myocardial infarction (40 vs 15% P=.01). Visual MCE was abnormal in 40 (51%) patients (60% in DM vs 46% in non DM P=0.04). SPECT was abnormal in 38 (48%) patients [60% in DM vs 42% non DM, P=0.01]. Reserve parameters were lower in DM vs. non DM patients: (β 1.77±1.12 vs 2.20±1.4, P<0.001 and MBF 2.86± 2.62 vs. 3.67±2.84, P<0.001). DM patients without CAD on SPECT had significantly lower β, and MBF reserve compared to non DM patients without CAD. Compared to SPECT, β reserve cutoff 1.6 had AUC 0.817, sensitivity 81%, and specificity 66% while MBF reserve cutoff 1.9 had AUC 0.760, sensitivity 79%, and specificity 63% in DM patients. Conclusion: Diabetes is associated with myocardial microvascular abnormalities as evidenced by abnormal myocardial perfusion on visual and quantitative MCE.

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Assessment of intravascular and extravascular mechanisms of myocardial perfusion abnormalities in obstructive hypertrophic cardiomyopathy by myocardial contrast echocardiography

Abstract: In patients with HCM, LV end-diastolic pressure, LV outflow tract pressure gradient, and LV mass index are independent predictors of rBV and hyperaemic MBF.

Cited by 40 publications

References 37 publications

Determinants of coronary microvascular dysfunction in symptomatic hypertrophic cardiomyopathy

Determinants of coronary microvascular dysfunction in symptomatic hypertrophic cardiomyopathy

PET/CT Assessment of Symptomatic Individuals with Obstructive and Nonobstructive Hypertrophic Cardiomyopathy

Detection of myocardial microvascular disease using contrast echocardiography during adenosine stress in type 2 diabetes mellitus: Prospective comparison with single-photon emission computed tomography

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