European Heart Journal Advance Access published online on June 29, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm246
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Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistent idiopathic atrial fibrillation
1 Department of Nuclear Medicine, University of Münster, Albert-Schweitzer-Str. 33, D-48149 Münster, Germany
2 Department of Cardiology and Angiology, University of Münster, Germany
3 Interdisciplinary Centre of Clinical Research (IZKF), University of Münster, Germany
Received 20 February 2007; revised 7 May 2007; accepted 22 May 2007.
* Corresponding author. Tel: +49 251 83 47362; fax: +49 251 83 47363. E-mail address: schafmi{at}uni-muenster.de
Aims: Patients with atrial fibrillation (AF) present with symptoms of myocardial ischaemia despite exclusion of coronary artery disease. A small vessel disease has been suggested. We quantified myocardial perfusion, perfusion reserve, and coronary vascular resistance (CVR) in AF patients using positron emission tomography (PET).
Methods and results: Twenty-five male patients (age: 58 ± 13 years) with persistent idiopathic AF were compared with 13 age- and risk-matched male controls (age: 56 ± 8 years). Using H215O-PET, myocardial blood flow (MBF) was quantified at rest, at hyperaemia (adenosine), and during cold-pressor-testing (CPT). Scans were repeated 4.1 ± 2.3 months after cardioversion in 10 AF patients. In AF, resting MBF (0.95 ± 0.19 vs. 1.14 ± 0.22 mL/min/mL; P = 0.009), hyperaemic MBF (2.07 ± 0.80 vs. 3.33 ± 0.78 mL/min/mL; P < 0.001), and MBF under CPT (0.90 ± 0.25 vs. 1.14 ± 0.25 mL/min/mL; P < 0.014) were significantly reduced compared with matched controls. Hyperaemic CVR was increased in AF (47 ± 21 vs. 29 ± 7 mmHg x mL/min/mL; P = 0.012) but unchanged at rest and under CPT. After cardioversion, resting MBF and MBF under CPT in AF were similar to matched controls, however, hyperaemic MBF and CVR were not recovered.
Conclusion: In AF, MBF at baseline, at hyperaemia, and at CPT is reduced, whereas CVR under hyperaemic conditions is increased. Following electrical cardioversion, these findings are partly reversible and therefore most likely secondary to the arrhythmia.
Key Words: Atrial fibrillation • Myocardial perfusion • Myocardial blood flow • Coronary vascular resistance • Positron emission tomography
The first two authors have contributed equally.
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