Myocardial blood flow response to pacing tachycardia and to dipyridamole infusion in patients with dilated cardiomyopathy without overt heart failure: A quantitative assessment by positron emission tomography

Danilo Neglia, Oberdan Parodi, Michela Gallopin, Gianmario Sambuceti, Assuero Giorgetti, Lorenza Pratali, Piero Salvadori, Claudio Michelassi, Maurizio Lunardi, Gualtiero Pelosi, Mario Marzilli, Antonio L'Abbate

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Abstract

Background: Myocardial blood flow (MBF) impairment has been documented in advanced dilated cardiomyopathy (DCM) in which hemodynamic factors, secondary to severe ventricular dysfunction, may limit myocardial perfusion. To assess whether MBF impairment in DCM may also be present independent of hemodynamic factors, the present study was designed to quantify myocardial perfusion in patients with mild disease without overt heart failure. Methods and Results: Absolute regional MBF (milliliters per minute per gram) was measured by positron emission tomography and 13N-ammonia in resting conditions, during pacinginduced tachycardia, and after dipyridamole infusion (0.56 mg/kg over 4 minutes) in 22 DCM patients and in 13 healthy subjects. Patients were in New York Heart Association functional class I-II and showed depressed left ventricular (LV) ejection fraction by radionuclide angiography (35±8%; range, 21% to 48%), normal coronary angiography, and normal or moderately increased LV end-diastolic pressure (9.2±5.5 mm Hg; range, 2 to 20 mm Hg). There were no differences in arterial blood pressure, heart rate, and rate-pressure product between patients and control subjects in the three study conditions. Compared with control subjects, DCM patients had lower mean MBF at rest (0.80±0.25 versus 1.08±0.20 mL · min-1 · g-1, P-1 · g-1, P-1 · g-1, P12 mm Hg; in 4, myocardial perfusion was severely depressed both at baseline and in response to stress. Conclusions: In patients with DCM without overt heart failure, myocardial perfusion is impaired both at rest and in response to vasodilating stimuli. The abnormalities in vasodilating capability can be present despite normal hemodynamics; progression of the disease is associated with more depressed myocardial perfusion.

Original languageEnglish
Pages (from-to)796-804
Number of pages9
JournalCirculation
Volume92
Issue number4
Publication statusPublished - Aug 15 1995

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Keywords

  • Blood flow
  • Cardiomyopathy
  • Microcirculation
  • Tomography

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Neglia, D., Parodi, O., Gallopin, M., Sambuceti, G., Giorgetti, A., Pratali, L., Salvadori, P., Michelassi, C., Lunardi, M., Pelosi, G., Marzilli, M., & L'Abbate, A. (1995). Myocardial blood flow response to pacing tachycardia and to dipyridamole infusion in patients with dilated cardiomyopathy without overt heart failure: A quantitative assessment by positron emission tomography. Circulation, 92(4), 796-804.