Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Coronary vasodilator reserve in primary and secondary left ventricular hypertrophy
A study with positron emission tomography
Cyclotron Unit, MRC Clinical Sciences Centre and Royal Postgraduate Medical School, Hammersmith Hospital London, U. K.
revised 19 February 1996; accepted 26 February 1996.
correspondence: Paolo G. Camici, MD. MRC Cyclotron Unit, Hammersmith Hospital, Du Cane Road, London W12 0NN. U.K.
Abstract
Objectives Coronary vasodilator reserve is reduced in hypertrophic cardiomyopathy and secondary left ventricular hypertrophy despite angiographically normal coronaries. The aim of the present study was to assess whether quantitative differences exist between these conditions.
Methods Using positron emission tomography with H215O, myocardial blood flow was measured at baseline and following intravenous dipyridamole (0·56 mg. kg –1) in 12 hypertrophic cardiomyopathy patients (age 34 (11) years, mean (SD), all male), 16 secondary left ventricular hypertrophy patients (age 58 (20) years, P<0·01 vs hypertrophic cardiomyopathy; 10 female) and 40 normal controls (age 54 (20), 13 female). In view of the known decline of post-dipyridamole myocardial blood flow with age, myocardial blood flow was compared between the patient groups and appropriately matched subsets of the total control group.
Results Baseline myocardial blood flow in the hypertrophic cardiomyopathy patients was 0·82 (0·23) ml. min–1 . g–1 vs 0·94 (0·14) ml. min–1 . g–1 in its matched control group, P=ns. For the secondary left ventricular hypertrophy patient group, baseline myocardial blood flow was 1·17 (0·40) ml . min–1 . g–1 vs 1·06 (0·28) ml . min–1 . g–1 for the secondary left ventricular hypertrophy matched control group, P=ns. Following dipyridamole, myocardial blood flow was 1·64 (0·44) ml . min–1 . g–1 in hypertrophic cardiomyopathy patients vs 3·50 (0·95) ml . min–1 . g–1for the hypertrophic cardiomyopathy matched control group, P=0·0001. For the left ventricular hypertrophy patients, post-dipyridamole myocardial blood flow was 2·27 (0·60)ml . min–1 . g–1 vs 2·94(1·29) ml . min–1 . g–1 for the left ventricular hypertrophy controls, P 0·06. Coronary vasodilator reserve (dipyridamole-myocardial blood flow/baseline-myocardial blood flow) was 2·05 (0·61) for hypertrophic cardiomyopathy patients vs 3·81 (0·98) for the hypertrophic cardiomyopathy controls (P=0 0001, patients vs controls) and 2·06 (0·62) for left ventricular hypertrophy patients vs 2·90 (1·38) for the left ventricular hypertrophy controls, P<0·03 patients vs controls. After correction of baseline myocardial blood flow for baseline heart rate x systolic pressure product, coronary vasodilator reserve for the hypertrophic cardiomyopathy patients was 2·06 (1·06) vs 4·34 (1·54) for the hypertrophic cardiomyopathy controls, P=0·0002 and in the secondary left ventricular hypertrophy patients, the values were 2·13 (0·64) vs 2·89 (1·42) in the secondary left ventricular hypertrophy controls, P<0·05.
Conclusions In both hypertrophic cardiomyopathy and secondary left ventricular hypertrophy, the computed coronary vasodilator reserve is impaired, even after correction for baseline cardiac work. However, the extent of the reduction is greater in the hypertrophic cardiomyopathy patients. In the blunting of vasodilator reserve of secondary left ventricular hypertrophy, the patients' greater hyperaemic response is partly offset by the higher baseline myocardial blood flow.
Key Words: Left ventricular hypertrophy • hypertrophic cardiomyopathy • arterial hypertension • aortic stenosis • coronary vasodilator reserve • positron emission tomography
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