Decreased Coronary Flow Reserve in Hypertrophic Cardiomyopathy Is Related to Remodeling of the Coronary Microcirculation

Krams, Rob; Kofflard, Marcel; Duncker, Dirk J.; Birgelen, C. von; Carlier, Stéphane; Kliffen, Mike; Cate, Folkert J. Ten; Serruys, Patrick W.

doi:10.1161/01.cir.97.3.230

Cited by 181 publications

(126 citation statements)

References 11 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…As a possible cause of decreased CBF reserve in patients with hypertensive LVH, increased CBF at baseline has been proposed (5). On the other hand, it has been reported that the reduced arteriolar lumen and inadequate capillary density in relation to the increased myocardial mass are causes of decreased coronary flow reserve in HCM patients (8,15). In our study, the CBF at baseline was increased in both the group with hypertensive LVH and the one with HCM dependent upon left ventricular mass.…”

Section: Cbf Reserve In Hypertensive Lvh and Hcmsupporting

confidence: 37%

Difference in Coronary Blood Flow Dynamics between Patients with Hypertension and Those with Hypertrophic Cardiomyopathy.

Misawa¹,

Nitta

Matsubara

et al. 2002

Hypertens Res

View full text Add to dashboard Cite

show abstract

Section: Cbf Reserve In Hypertensive Lvh and Hcmsupporting

confidence: 37%

Difference in Coronary Blood Flow Dynamics between Patients with Hypertension and Those with Hypertrophic Cardiomyopathy.

Misawa¹,

Nitta

Matsubara

et al. 2002

Hypertens Res

View full text Add to dashboard Cite

show abstract

“…Microvascular dysfunction results in a blunted perfusion reserve [31,32] and subsequent myocardial ischaemia during stress [33], even in the non-hypertrophied LV free wall [32]. Therefore, in analogy to ischaemic heart disease due to CAD, repetitive stunning of the myocardium in HCM might contribute to deteriorating efficiency.…”

Section: Myocardial Efficiencymentioning

confidence: 99%

“…myocardial efficiency, was reduced not only in the hypertrophied septum but also in the lateral wall [2]. Similarly, an impaired energetic status as reflected by the phosphocreatine to adenosine triphosphate ratio, derived by 31 P spectroscopy, has been documented in different stages of the disease process [3][4][5][6]. Although prognostic data related to an impaired energetic state in HCM are lacking, in analogy with other cardiomyopathies, it is believed to be of prognostic relevance [7,8].…”

Section: Introductionmentioning

confidence: 99%

Determinants of myocardial energetics and efficiency in symptomatic hypertrophic cardiomyopathy

Timmer

Germans

Götte

et al. 2010

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Purpose Next to hypertrophy, hypertrophic cardiomyopathy (HCM) is characterized by alterations in myocardial energetics. A small number of studies have shown that myocardial external efficiency (MEE), defined by external work (EW) in relation to myocardial oxidative metabolism (MVO 2 ), is reduced. The present study was conducted to identify determinants of MEE in patients with HCM by use of dynamic positron emission tomography (PET) and cardiovascular magnetic resonance imaging (CMR). Methods Twenty patients with HCM (12 men, mean age: 55.2 ± 13.9 years) and 11 healthy controls (7 men, mean age: 48.1 ± 10 years) were studied with [ 11 C]acetate PET to assess MVO 2 . CMR was performed to determine left ventricular (LV) volumes and mass (LVM). Univariate and multivariate analyses were employed to determine independent predictors of myocardial efficiency.Results Between study groups, MVO 2 (controls: 0.12 ± 0.04 ml·min −1 ·g −1 , HCM: 0.13 ± 0.05 ml·min −1 ·g −1 , p = 0.64) and EW (controls: 9,139 ± 2,484 mmHg·ml, HCM: 9,368 ± 2,907 mmHg·ml, p = 0.83) were comparable, whereas LVM was significantly higher (controls: 99 ± 21 g, HCM: 200 ± 76 g, p < 0.001) and MEE was decreased in HCM patients (controls: 35 ± 8%, HCM: 21 ± 10%, p < 0.001). MEE was related to stroke volume (SV), LV outflow tract gradient, NH 2 -terminal pro-brain natriuretic peptide (NT-proBNP) and serum free fatty acid levels (all p < 0.05). Multivariate analysis revealed that SV (ß = 0.74, p < 0.001) and LVM (ß = −0.43, p = 0.013) were independently related to MEE. Conclusion HCM is characterized by unaltered MVO 2 , impaired EW generation per gram of myocardial tissue and subsequent deteriorated myocardial efficiency. Mechanical external efficiency could independently be predicted by SV and LVM.

show abstract

“…LVOT obstruction and/or LV cavity obliteration can not explain the mechanism because the majority of our HCM patients with the "√"-shaped strain-rate waveform had neither. In patients with HCM, it is reported that myocardial ischemia can be caused by an imbalance between myocardial oxygen supply and demand associated with prominent hypertrophy [14,15]. Myocardial ischemia and the resultant fibrosis can induce a delay in contraction, but it seems unlikely to cause the mid-systolic interruption of myocardial contraction.…”

Section: Mechanism Of Abnormal Systolic Strain Rate Waveform In Hcmmentioning

confidence: 99%

Characteristic systolic waveform of left ventricular longitudinal strain rate in patients with hypertrophic cardiomyopathy

et al. 2016

View full text Add to dashboard Cite

We analyzed the waveform of systolic strain and strain-rate curves to find a characteristic left ventricular (LV) myocardial contraction pattern in patients with hypertrophic cardiomyopathy (HCM), and evaluated the utility of these parameters for the differentiation of HCM and LV hypertrophy secondary to hypertension (HT). From global strain and strain-rate curves in the longitudinal and circumferential directions, the time from mitral valve closure to the peak strains (T-LS and T-CS, respectively) and the peak systolic strain rates (T-LSSR and T-CSSR, respectively) were measured in 34 patients with HCM, 30 patients with HT and 25 control subjects. The systolic strain-rate waveform was classified into 3 patterns ("V", "W", and "√" pattern). In the HCM group, T-LS was prolonged, but T-LSSR was shortened; consequently, T-LSSR/T-LS ratio was distinctly lower than in the HT and control groups. The "√" pattern of longitudinal strain-rate waveform was more frequently seen in the HCM group (74%) than in the control (4%) and HT (20%) groups. Similar but less distinct results were obtained in the circumferential direction. To differentiate HCM from HT, the sensitivity and specificity of the T-LSSR/T-LS ratio <0.34 and the "√"-shaped longitudinal strain-rate waveform were 85% and 63%, and 74% and 80%, respectively. In conclusion, in patients with HCM, a reduced T-LSSR/T-LS ratio and a characteristic "√"-shaped waveform of LV systolic strain rate was seen, especially in the longitudinal direction. The timing and waveform analyses of systolic strain rate may be useful to distinguish between HCM and HT.

show abstract

Decreased Coronary Flow Reserve in Hypertrophic Cardiomyopathy Is Related to Remodeling of the Coronary Microcirculation

Cited by 181 publications

References 11 publications

Difference in Coronary Blood Flow Dynamics between Patients with Hypertension and Those with Hypertrophic Cardiomyopathy.

Difference in Coronary Blood Flow Dynamics between Patients with Hypertension and Those with Hypertrophic Cardiomyopathy.

Determinants of myocardial energetics and efficiency in symptomatic hypertrophic cardiomyopathy

Characteristic systolic waveform of left ventricular longitudinal strain rate in patients with hypertrophic cardiomyopathy

Contact Info

Product

Resources

About