Transmural myocardial blood flow distribution in hypertrophic cardiomyopathy and effect of treatment

L. Choudhury, P. Elliott, O. Rimoldi, M. Ryan, A. A. Lammertsma, H. Boyd, W. J. McKenna, P. G. Camici

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Verapamil alleviates symptoms in patients with hypertrophic cardiomyopathy (HCM), but the underlying mechanism of improvement remains speculative. Baseline and dipyridamole myocardial blood flow (MBF) were measured in 15 HCM patients (14 men, 42 ± 10 years), before and after 4 weeks of verapamil SR 480 mg daily, using 15O labelled water and positron emission tomography (PET). Subendocardial (endo) and subepicardial (epi) MBF was measured in the septum (thickness 25.4 ± 5.8 mm). Pre-treatment baseline whole heart MBF was 1.02 ± 0.28 ml/min/g and 1.01 ± 0.30 ml/min/g on treatment (p = ns). Dipyridamole MBF was 1.39 ± 0.31 ml/min/g off treatment and 1.23 ± 0.34 ml/min/g on treatment (p = ns). Coronary flow reserve (dipyridamole/resting MBF) was 1.45 ± 0.52 and 1.30 ± 0.51, respectively (p = ns). At baseline, the septal endo/epi MBF ratio was uniform off and on treatment (1.13 ± 0.18 vs 1.18 ± 0.21, p = ns). Before treatment, the endo/epi ratio following dipyridamole decreased to 0.93 ± 0.24 (p <0.01 vs baseline) and 5/15 (33%) patients had a ratio <0.8 which would suggest subendocardial underperfusion. During treatment, the endo/epi ratio following dipyridamole was no more different from baseline (1.06 ± 0.24, p = ns vs baseline) and 2/14 (14 %) patients had an endo/epi <0.8. PET can be successfully used to determine transmural MBF in vivo in patients with hypertrophied ventricles. Despite symptomatic improvement, high dose verapamil therapy does not increase total MBF in patients with HCM but may improve septal transmural MBF distribution during dipyridamole in some patients.

Original languageEnglish
Pages (from-to)49-59
Number of pages11
JournalBasic Research in Cardiology
Volume94
Issue number1
DOIs
Publication statusPublished - Feb 1999

Fingerprint

Hypertrophic Cardiomyopathy
Dipyridamole
Verapamil
Therapeutics
Positron-Emission Tomography
Water

Keywords

  • Calcium channel blockers
  • Hypertrophic cardiomyopathy
  • Positron emission tomography
  • Transmural blood flow

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Transmural myocardial blood flow distribution in hypertrophic cardiomyopathy and effect of treatment. / Choudhury, L.; Elliott, P.; Rimoldi, O.; Ryan, M.; Lammertsma, A. A.; Boyd, H.; McKenna, W. J.; Camici, P. G.

In: Basic Research in Cardiology, Vol. 94, No. 1, 02.1999, p. 49-59.

Research output: Contribution to journalArticle

Choudhury, L, Elliott, P, Rimoldi, O, Ryan, M, Lammertsma, AA, Boyd, H, McKenna, WJ & Camici, PG 1999, 'Transmural myocardial blood flow distribution in hypertrophic cardiomyopathy and effect of treatment', Basic Research in Cardiology, vol. 94, no. 1, pp. 49-59. https://doi.org/10.1007/s003950050126
Choudhury, L. ; Elliott, P. ; Rimoldi, O. ; Ryan, M. ; Lammertsma, A. A. ; Boyd, H. ; McKenna, W. J. ; Camici, P. G. / Transmural myocardial blood flow distribution in hypertrophic cardiomyopathy and effect of treatment. In: Basic Research in Cardiology. 1999 ; Vol. 94, No. 1. pp. 49-59.
@article{67f59a23f50342409fb2d4d6036b0478,
title = "Transmural myocardial blood flow distribution in hypertrophic cardiomyopathy and effect of treatment",
abstract = "Verapamil alleviates symptoms in patients with hypertrophic cardiomyopathy (HCM), but the underlying mechanism of improvement remains speculative. Baseline and dipyridamole myocardial blood flow (MBF) were measured in 15 HCM patients (14 men, 42 ± 10 years), before and after 4 weeks of verapamil SR 480 mg daily, using 15O labelled water and positron emission tomography (PET). Subendocardial (endo) and subepicardial (epi) MBF was measured in the septum (thickness 25.4 ± 5.8 mm). Pre-treatment baseline whole heart MBF was 1.02 ± 0.28 ml/min/g and 1.01 ± 0.30 ml/min/g on treatment (p = ns). Dipyridamole MBF was 1.39 ± 0.31 ml/min/g off treatment and 1.23 ± 0.34 ml/min/g on treatment (p = ns). Coronary flow reserve (dipyridamole/resting MBF) was 1.45 ± 0.52 and 1.30 ± 0.51, respectively (p = ns). At baseline, the septal endo/epi MBF ratio was uniform off and on treatment (1.13 ± 0.18 vs 1.18 ± 0.21, p = ns). Before treatment, the endo/epi ratio following dipyridamole decreased to 0.93 ± 0.24 (p <0.01 vs baseline) and 5/15 (33{\%}) patients had a ratio <0.8 which would suggest subendocardial underperfusion. During treatment, the endo/epi ratio following dipyridamole was no more different from baseline (1.06 ± 0.24, p = ns vs baseline) and 2/14 (14 {\%}) patients had an endo/epi <0.8. PET can be successfully used to determine transmural MBF in vivo in patients with hypertrophied ventricles. Despite symptomatic improvement, high dose verapamil therapy does not increase total MBF in patients with HCM but may improve septal transmural MBF distribution during dipyridamole in some patients.",
keywords = "Calcium channel blockers, Hypertrophic cardiomyopathy, Positron emission tomography, Transmural blood flow",
author = "L. Choudhury and P. Elliott and O. Rimoldi and M. Ryan and Lammertsma, {A. A.} and H. Boyd and McKenna, {W. J.} and Camici, {P. G.}",
year = "1999",
month = "2",
doi = "10.1007/s003950050126",
language = "English",
volume = "94",
pages = "49--59",
journal = "Basic Research in Cardiology",
issn = "0300-8428",
publisher = "D. Steinkopff-Verlag",
number = "1",

}

TY - JOUR

T1 - Transmural myocardial blood flow distribution in hypertrophic cardiomyopathy and effect of treatment

AU - Choudhury, L.

AU - Elliott, P.

AU - Rimoldi, O.

AU - Ryan, M.

AU - Lammertsma, A. A.

AU - Boyd, H.

AU - McKenna, W. J.

AU - Camici, P. G.

PY - 1999/2

Y1 - 1999/2

N2 - Verapamil alleviates symptoms in patients with hypertrophic cardiomyopathy (HCM), but the underlying mechanism of improvement remains speculative. Baseline and dipyridamole myocardial blood flow (MBF) were measured in 15 HCM patients (14 men, 42 ± 10 years), before and after 4 weeks of verapamil SR 480 mg daily, using 15O labelled water and positron emission tomography (PET). Subendocardial (endo) and subepicardial (epi) MBF was measured in the septum (thickness 25.4 ± 5.8 mm). Pre-treatment baseline whole heart MBF was 1.02 ± 0.28 ml/min/g and 1.01 ± 0.30 ml/min/g on treatment (p = ns). Dipyridamole MBF was 1.39 ± 0.31 ml/min/g off treatment and 1.23 ± 0.34 ml/min/g on treatment (p = ns). Coronary flow reserve (dipyridamole/resting MBF) was 1.45 ± 0.52 and 1.30 ± 0.51, respectively (p = ns). At baseline, the septal endo/epi MBF ratio was uniform off and on treatment (1.13 ± 0.18 vs 1.18 ± 0.21, p = ns). Before treatment, the endo/epi ratio following dipyridamole decreased to 0.93 ± 0.24 (p <0.01 vs baseline) and 5/15 (33%) patients had a ratio <0.8 which would suggest subendocardial underperfusion. During treatment, the endo/epi ratio following dipyridamole was no more different from baseline (1.06 ± 0.24, p = ns vs baseline) and 2/14 (14 %) patients had an endo/epi <0.8. PET can be successfully used to determine transmural MBF in vivo in patients with hypertrophied ventricles. Despite symptomatic improvement, high dose verapamil therapy does not increase total MBF in patients with HCM but may improve septal transmural MBF distribution during dipyridamole in some patients.

AB - Verapamil alleviates symptoms in patients with hypertrophic cardiomyopathy (HCM), but the underlying mechanism of improvement remains speculative. Baseline and dipyridamole myocardial blood flow (MBF) were measured in 15 HCM patients (14 men, 42 ± 10 years), before and after 4 weeks of verapamil SR 480 mg daily, using 15O labelled water and positron emission tomography (PET). Subendocardial (endo) and subepicardial (epi) MBF was measured in the septum (thickness 25.4 ± 5.8 mm). Pre-treatment baseline whole heart MBF was 1.02 ± 0.28 ml/min/g and 1.01 ± 0.30 ml/min/g on treatment (p = ns). Dipyridamole MBF was 1.39 ± 0.31 ml/min/g off treatment and 1.23 ± 0.34 ml/min/g on treatment (p = ns). Coronary flow reserve (dipyridamole/resting MBF) was 1.45 ± 0.52 and 1.30 ± 0.51, respectively (p = ns). At baseline, the septal endo/epi MBF ratio was uniform off and on treatment (1.13 ± 0.18 vs 1.18 ± 0.21, p = ns). Before treatment, the endo/epi ratio following dipyridamole decreased to 0.93 ± 0.24 (p <0.01 vs baseline) and 5/15 (33%) patients had a ratio <0.8 which would suggest subendocardial underperfusion. During treatment, the endo/epi ratio following dipyridamole was no more different from baseline (1.06 ± 0.24, p = ns vs baseline) and 2/14 (14 %) patients had an endo/epi <0.8. PET can be successfully used to determine transmural MBF in vivo in patients with hypertrophied ventricles. Despite symptomatic improvement, high dose verapamil therapy does not increase total MBF in patients with HCM but may improve septal transmural MBF distribution during dipyridamole in some patients.

KW - Calcium channel blockers

KW - Hypertrophic cardiomyopathy

KW - Positron emission tomography

KW - Transmural blood flow

UR - http://www.scopus.com/inward/record.url?scp=0032934530&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032934530&partnerID=8YFLogxK

U2 - 10.1007/s003950050126

DO - 10.1007/s003950050126

M3 - Article

VL - 94

SP - 49

EP - 59

JO - Basic Research in Cardiology

JF - Basic Research in Cardiology

SN - 0300-8428

IS - 1

ER -