Coronary vasodilation is impaired in both hypertrophied and nonhypertrophied myocardium of patients with hypertrophic cardiomyopathy: A study with nitrogen-13 ammonia and positron emission tomography

Paolo Camici, Giampaolo Chiriatti, Roberto Lorenzoni, Riccardo C. Bellina, Roberto Gistri, Gessica Italiani, Oberdan Parodi, Piero A. Salvadori, Nicola Nista, Lauro Papi, Antonio L'abbate

Research output: Contribution to journalArticle

Abstract

To assess regional coronary reserve in hypertrophic cardiomyopathy, regional myocardial blood flow was measured in 23 patients with hypertrophic cardiomyopathy and 12 control subjects by means of nitrogen-13 ammonia and dynamic positron emission tomography. In patients with hypertrophic cardiomyopathy at baseline study, regional myocardial blood flow was 1.14 ± 0.43 ml/min per g in the hypertrophied (20 ± 3 mm) interventricular septum and 0.90 ± 0.35 ml/min per g (p <0.05 versus septal flow) in the nonhypertrophied (10 ± 2 mm) left ventricular free wall. These were not statistically different from the corresponding values in control subjects (1.04 ± 0.25 and 0.91 ± 0.21 ml/min per g, respectively, p = NS). After pharmacologically induced coronary vasodilation (dipyridamole, 0.56 mg/kg intravenously over 4 min), regional myocardial blood flow in patients with hypertrophic cardiomyopathy increased significantly less than in control subjects both in the septum (1.63 ± 0.58 versus 2.99 ± 1.06 ml/min per g, p <0.001) and in the free wall (1.47 ± 0.58 versus 2.44 ± 0.82 ml min per g, p <0.001). In addition, patients with hypertrophic cardiomyopathy who had a history of chest pain had more pronounced impairment of coronary vasodilator reserve than did those without a history of chest pain. After dipyridamole, coronary resistance in the septum decreased by 38% in patients without a history of chest pain, but decreased by only 14% in those with such a history (p <0.05). Coronary resistance in the free wall decreased by 45% in patients without and by 27% in those with a history of chest pain (p = 0.06). These results show that, in patients with hypertrophic cardiomyopathy, coronary vasodilator reserve is abnormal not only in the hypertrophied interventricular septum, but also in the nonhypertrophied free wall of the left ventricle. This finding suggests that the reduction in coronary reserve is not necessarily due to myocardial hypertrophy, but may be a primary defect.

Original languageEnglish
Pages (from-to)879-886
Number of pages8
JournalJournal of the American College of Cardiology
Volume17
Issue number4
DOIs
Publication statusPublished - Mar 15 1991

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Hypertrophic Cardiomyopathy
Ammonia
Vasodilation
Positron-Emission Tomography
Myocardium
Nitrogen
Chest Pain
Regional Blood Flow
Dipyridamole
Vasodilator Agents
Hypertrophy
Heart Ventricles
History

ASJC Scopus subject areas

  • Nursing(all)

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Coronary vasodilation is impaired in both hypertrophied and nonhypertrophied myocardium of patients with hypertrophic cardiomyopathy : A study with nitrogen-13 ammonia and positron emission tomography. / Camici, Paolo; Chiriatti, Giampaolo; Lorenzoni, Roberto; Bellina, Riccardo C.; Gistri, Roberto; Italiani, Gessica; Parodi, Oberdan; Salvadori, Piero A.; Nista, Nicola; Papi, Lauro; L'abbate, Antonio.

In: Journal of the American College of Cardiology, Vol. 17, No. 4, 15.03.1991, p. 879-886.

Research output: Contribution to journalArticle

Camici, Paolo ; Chiriatti, Giampaolo ; Lorenzoni, Roberto ; Bellina, Riccardo C. ; Gistri, Roberto ; Italiani, Gessica ; Parodi, Oberdan ; Salvadori, Piero A. ; Nista, Nicola ; Papi, Lauro ; L'abbate, Antonio. / Coronary vasodilation is impaired in both hypertrophied and nonhypertrophied myocardium of patients with hypertrophic cardiomyopathy : A study with nitrogen-13 ammonia and positron emission tomography. In: Journal of the American College of Cardiology. 1991 ; Vol. 17, No. 4. pp. 879-886.
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abstract = "To assess regional coronary reserve in hypertrophic cardiomyopathy, regional myocardial blood flow was measured in 23 patients with hypertrophic cardiomyopathy and 12 control subjects by means of nitrogen-13 ammonia and dynamic positron emission tomography. In patients with hypertrophic cardiomyopathy at baseline study, regional myocardial blood flow was 1.14 ± 0.43 ml/min per g in the hypertrophied (20 ± 3 mm) interventricular septum and 0.90 ± 0.35 ml/min per g (p <0.05 versus septal flow) in the nonhypertrophied (10 ± 2 mm) left ventricular free wall. These were not statistically different from the corresponding values in control subjects (1.04 ± 0.25 and 0.91 ± 0.21 ml/min per g, respectively, p = NS). After pharmacologically induced coronary vasodilation (dipyridamole, 0.56 mg/kg intravenously over 4 min), regional myocardial blood flow in patients with hypertrophic cardiomyopathy increased significantly less than in control subjects both in the septum (1.63 ± 0.58 versus 2.99 ± 1.06 ml/min per g, p <0.001) and in the free wall (1.47 ± 0.58 versus 2.44 ± 0.82 ml min per g, p <0.001). In addition, patients with hypertrophic cardiomyopathy who had a history of chest pain had more pronounced impairment of coronary vasodilator reserve than did those without a history of chest pain. After dipyridamole, coronary resistance in the septum decreased by 38{\%} in patients without a history of chest pain, but decreased by only 14{\%} in those with such a history (p <0.05). Coronary resistance in the free wall decreased by 45{\%} in patients without and by 27{\%} in those with a history of chest pain (p = 0.06). These results show that, in patients with hypertrophic cardiomyopathy, coronary vasodilator reserve is abnormal not only in the hypertrophied interventricular septum, but also in the nonhypertrophied free wall of the left ventricle. This finding suggests that the reduction in coronary reserve is not necessarily due to myocardial hypertrophy, but may be a primary defect.",
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AU - Camici, Paolo

AU - Chiriatti, Giampaolo

AU - Lorenzoni, Roberto

AU - Bellina, Riccardo C.

AU - Gistri, Roberto

AU - Italiani, Gessica

AU - Parodi, Oberdan

AU - Salvadori, Piero A.

AU - Nista, Nicola

AU - Papi, Lauro

AU - L'abbate, Antonio

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N2 - To assess regional coronary reserve in hypertrophic cardiomyopathy, regional myocardial blood flow was measured in 23 patients with hypertrophic cardiomyopathy and 12 control subjects by means of nitrogen-13 ammonia and dynamic positron emission tomography. In patients with hypertrophic cardiomyopathy at baseline study, regional myocardial blood flow was 1.14 ± 0.43 ml/min per g in the hypertrophied (20 ± 3 mm) interventricular septum and 0.90 ± 0.35 ml/min per g (p <0.05 versus septal flow) in the nonhypertrophied (10 ± 2 mm) left ventricular free wall. These were not statistically different from the corresponding values in control subjects (1.04 ± 0.25 and 0.91 ± 0.21 ml/min per g, respectively, p = NS). After pharmacologically induced coronary vasodilation (dipyridamole, 0.56 mg/kg intravenously over 4 min), regional myocardial blood flow in patients with hypertrophic cardiomyopathy increased significantly less than in control subjects both in the septum (1.63 ± 0.58 versus 2.99 ± 1.06 ml/min per g, p <0.001) and in the free wall (1.47 ± 0.58 versus 2.44 ± 0.82 ml min per g, p <0.001). In addition, patients with hypertrophic cardiomyopathy who had a history of chest pain had more pronounced impairment of coronary vasodilator reserve than did those without a history of chest pain. After dipyridamole, coronary resistance in the septum decreased by 38% in patients without a history of chest pain, but decreased by only 14% in those with such a history (p <0.05). Coronary resistance in the free wall decreased by 45% in patients without and by 27% in those with a history of chest pain (p = 0.06). These results show that, in patients with hypertrophic cardiomyopathy, coronary vasodilator reserve is abnormal not only in the hypertrophied interventricular septum, but also in the nonhypertrophied free wall of the left ventricle. This finding suggests that the reduction in coronary reserve is not necessarily due to myocardial hypertrophy, but may be a primary defect.

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