Clinical InvestigationHypertrophic CardiomyopathyRegional Difference of Microcirculation in Patients with Asymmetric Hypertrophic Cardiomyopathy: Transthoracic Doppler Coronary Flow Velocity Reserve Analysis
Section snippets
Study Population
We prospectively included 64 patients with asymmetric HC; but, due to a technical inability to assess CFVR in both arteries in 3 patients, the final group consisted of 61 patients (27 men, 34 women; mean age, 49 ± 16 years). The patients were evaluated at the Clinic of Cardiology, Clinical Center of Serbia, during the period October 2007 to March 2011. Patients' clinical characteristics, New York Heart Association (NYHA) class, the presence of arrhythmia on 24-hour Holter monitoring, and
Results
Of 64 patients, 1 patient was excluded because of a technically inadequate coronary flow signal in LAD artery during hyperemia, whereas 2 patients were excluded due to an inability to visualize baseline coronary flow in PD artery. Thus, feasibility to assess CFVR for patients with HC was 98.4% for LAD, and 96.7% for PD. According to the presence of LV outflow tract gradient at rest (≥30 mm Hg), the patients were divided into 20 patients who had HOCM, and 41 patients with HCM.
Clinical
Discussion
To the best of our knowledge, our study is the first to report dual assessment and the high feasibility of CFVR by transthoracic Doppler echocardiography in patients with HC. Similar studies to assess regional difference of microcirculation in patients with HC were done by using PET,3, 16, 17 intracoronary Doppler wire,8, 18 magnetic resonance imaging,19 and transthoracic contrast echocardiography.6 Results of our study demonstrated that regional differences of CFVR are present only in patients
Conclusions
CFVR was impaired in both hypertrophic and nonhypertrophic regions of the LV in patients with HC. CFVR LAD and relative CFVR were significantly lower in patients with HOCM compared with patients with HCM. Regional differences of CFVR are present only in patients with significant LV outflow tract obstruction, which suggests that obstruction per se, by increasing wall stress in basal conditions, leads to higher basal diastolic coronary flow velocities and results in lower CFVR in LAD compared
Acknowledgment
This study was partially supported by the grants of the Ministry of Education and Science of the Republic of Serbia (Grant Nos. III41022 and ON175086).
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Cited by (23)
Blunted coronary flow velocity reserve is associated with impairment in systolic function and functional capacity in hypertrophic cardiomyopathy
2022, International Journal of CardiologyCitation Excerpt :Comparing to values published for controls [7,22], we found higher values of CFV at baseline in patients with HCM. By Doppler echocardiography and by cardiac catheterization using a Doppler wire, it was previously demonstrated an increase in basal diastolic coronary flow and lower coronary flow reserve in patients with HCM comparing to normal subjects [7,22–24]. At rest conditions, patients with HCM have recruitment of vasodilatory capacity in order to maintain flow per unit mass of myocardium, and so to supply oxygen demand of the hypertrophied myocardium [25,26].
Invasive Assessment of Microvascular Resistance in Hypertrophic Cardiomyopathy With Echocardiographic Correlates
2022, Heart Lung and CirculationCitation Excerpt :Non-invasive testing showed that reduced hyperaemic myocardial blood flow was associated with a combination of extrinsic compressive forces in addition to decreased capillary density and other pathological changes within the hypertrophied myocardium [11]. In addition, echocardiographic assessment showed regional differences in coronary flow velocity reserve between the LAD and posterior descending artery in hypertrophic cardiomyopathy subjects with and without left ventricular outflow tract obstruction [12]. IMR was reported to be elevated in patients with hypertension [13].
Prognostic Value of Transthoracic Doppler Echocardiography Coronary Flow Velocity Reserve in Patients with Nonculprit Stenosis of Intermediate Severity Early after Primary Percutaneous Coronary Intervention
2018, Journal of the American Society of EchocardiographyN-terminal pro-brain natriuretic peptide is related with coronary flow velocity reserve and diastolic dysfunction in patients with asymmetric hypertrophic cardiomyopathy
2017, Journal of CardiologyCitation Excerpt :Also, reduced CFVR in patients with HCM was identified as a important marker of prognosis and poor survival [16,30]. The explanations of the relationship between myocardial ischemia and elevated NT-pro-BNP in HCM are conflicting and have been examined in only a few studies [1,9,16,29]. Ischemia itself, rather than changes in LV wall stress, may promote the release of BNP [1,6,38], as demonstrated by transient increase in BNP, during percutaneous transluminal coronary angioplasty [39].
A Comprehensive Review of Stress Testing in Hypertrophic Cardiomyopathy: Assessment of Functional Capacity, Identification of Prognostic Indicators, and Detection of Coronary Artery Disease
2017, Journal of the American Society of EchocardiographyPrognostic role of stress echocardiography in hypertrophic cardiomyopathy: The International Stress Echo Registry
2016, International Journal of CardiologyCitation Excerpt :The SE assessment might include an evaluation – feasible today – of all major variables potentially involved in generating symptoms in HCM patients, including those missed in the present study, such as diastolic function and mitral regurgitation. It is interesting that the only SE variable recommended today by the guidelines on the basis of the available evidence (i.e. left ventricular outflow tract obstruction during stress in symptomatic patients with resting gradient < 50 mm Hg, class IB) was by far less useful for risk stratification purposes than wall motion abnormalities (usually discarded as a frequent source of false positive responses also occurring in patients with angiographically normal coronary arteries) and reduction in CFVR, which may occur in HCM independently of underlying epicardial coronary artery disease for left ventricular hypertrophy, microvascular disease largely unrelated to the presence and severity of left ventricular hypertrophy and increased intraparietal extravascular resistances with reduction of diastolic suction forces [8,13,33]. “False positive” SE responses based on more advanced ischemia leading to wall motion abnormalities, or more localized sub-endocardial reduction in flow reserve leading to reduction in CFVR without overt wall motion abnormalities, may overturn into prognostic truths when risk stratification, rather than diagnosis of coronary artery disease, is the purpose of imaging.
The authors declare no conflict of interest.