Relation of Coronary Microvascular Dysfunction in Hypertrophic Cardiomyopathy to Contractile Dysfunction Independent from Myocardial Injury

SAJ Timmer, T Germans, MJW Gotte, IK Russel, M Lubberink, JM v.d. Berg, Folkert ten Cate, AA Lammertsma, P Knaapen, AC van Rossum

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We studied the spatial relations among hyperemic myocardial blood flow (hMBF), contractile function, and morphologic tissue alterations in 19 patients with hypertrophic cardiomyopathy (HC). All patients were studied with oxygen-15 water positron emission tomography during rest and adenosine administration to assess myocardial perfusion. Cardiovascular magnetic resonance was performed to derive delayed contrast-enhanced images and to calculate contractile function (E(cc)) with tissue tagging. Eleven healthy subjects underwent similar positron emission tomographic and cardiovascular magnetic resonance scanning protocols and served as a control group. In the HC group, hMBF averaged 2.46 +/- 0.91 ml/min/g and mean E(cc) was -14.7 +/- 3.4%, which were decreased compared to the control group (3.97 +/- 1.48 ml/min/g and -17.7 +/- 3.2%, respectively, p <0.001 for the 2 comparisons). Delayed contrast enhancement (DCE) was present only in patients with HC, averaging 6.2 +/- 10.3% of left ventricular mass. In the HC group, E(cc) and DCE in the septum (-13.7 +/- 3.6% and 10.2 +/- 13.6%) significantly differed from the lateral wall (-16.0 +/- 2.8% and 2.4 +/- 5.9%, p <0.001 for the 2 comparisons). In general, hMBF and E(cc) were decreased in segments displaying DCE compared to nonenhanced segments (p <0.001 for the comparisons). In the HC group, univariate analysis revealed relations of hMBF to E(cc) (r = -0.45, p <0.001) and DCE (r = -0.31, p <0.001). Multivariate analysis revealed that E(cc) was independently related to hMBF (beta -0.37, p <0.001) and DCE (beta 0.28, p <0.001). In conclusion, in HC hMBF is impaired and related to contractile function independent from presence of DCE. When present, DCE reflected a progressed disease state as characterized by an increased perfusion deficit and contractile dysfunction. (C) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107:1522-1528)
Original languageUndefined/Unknown
Pages (from-to)1522-1528
Number of pages7
JournalAmerican Journal of Cardiology
Issue number10
Publication statusPublished - 2011

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