Relevance of coronary microvascular flow impairment to long-term remodeling and systolic dysfunction in hypertrophic cardiomyopathy
Relevance of coronary microvascular flow impairment to long-term remodeling and systolic dysfunction in hypertrophic cardiomyopathy
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DOI：
10.1016/j.jacc.2005.10.050
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发表时间：
2006-03-07
影响因子：
24
通讯作者：
Camici, PG
中科院分区：
文献类型：
--
作者：
Olivotto, I;Cecchi, F;Camici, PG
结论本研究旨在评估是否通过正电子发射断层扫描（PET）评估微血管功能障碍的实体，预测肥厚型心肌病（HCM）左心室（LV）重塑和收缩功能障碍的长期发展。冠状动脉微血管功能障碍的因果作用已被建议为潜在的病理生理mechanism.METHODS 51例（纽约心脏协会功能I至II级）进行了随访8.1 +/- 2.1年后，测量静息和潘生丁（Dip）心肌血流量（MBF）。左心室收缩功能障碍定义为射血分数（LVEF）<50%。结果与健康对照组相比，HCM患者的Dip-MBF变钝（1.50 +/- 0.69 ml/min/g vs. 2.71 +/- 0.94 ml/min/g; p < 0.001）。在最终评估时，11例患者（22%）的LVEF < 50%;在大多数患者（n = 7）中，收缩功能障碍与随访期间LV腔尺寸显著增加（> 5 mm）相关。这11例患者的Dip-MBF低于40例左室功能正常的患者（分别为1.04 +/- 0.38 ml/min/g vs. 1.63 +/- 0.71 ml/min/g; p = 0.001）; 5例临床进展为严重心力衰竭症状或死亡的患者的Dip-MBF尤其迟钝（Dip-MBF 0.89 +/- 0.15 ml/min/g）。在多变量分析中，收缩功能障碍的两个独立预测因素是最低三分位数的Dip-MBF（< 1.1 ml/min/g;相对危险度，7.5; p = 0.038）和舒张末期LV尺寸在最高三分位数（> 45 mm;相对危险度为12.3;结论：重度微血管功能障碍是HCM患者左室重构和收缩功能障碍的长期预测因子。我们的研究结果表明微血管功能障碍是预防HCM疾病进展和心力衰竭的潜在靶点。
OBJECTIVES This study sought to evaluate whether the entity of microvascular dysfunction, assessed by positron emission tomography (PET), predicts the long-term development of left ventricular (LV) remodeling and systolic dysfunction in hypertrophic cardiomyopathy (HCM).BACKGROUND A subgroup of patients with HCM developed LV dilation and systolic impairment. A causal role of coronary microvascular dysfunction has been suggested as the underlying pathophysiological mechanism.METHODS Fifty-one patients (New York Heart Association functional class I to II) were followed up for 8.1 +/- 2.1 years after measurement of resting and dipyridamole (Dip) myocardial blood flow (MBF). Left ventricular systolic dysfunction was defined as an ejection fraction (LVEF) < 50%.RESULTS The Dip-MBF was blunted in HCM patients compared with a group of healthy control patients (1.50 +/- 0.69 ml/min/g vs. 2.71 +/- 0.94 ml/min/g; p < 0.001). At final evaluation, 11 patients (22%) had an LVEF < 50%; in most (n = 7), systolic dysfunction was associated with a significant increase in LV cavity dimensions (> 5 mm) during follow-up. These 11 patients showed lower Dip-MBF than the 40 with preserved LV function (1.04 +/- 0.38 ml/min/g vs. 1.63 +/- 0.71 ml/min/g, respectively; p = 0.001); Dip-MBF was particularly blunted in five patients with clinical progression to severe heart failure symptoms or death (Dip-MBF 0.89 +/- 0.15 ml/min/g). At multivariate analysis, the two independent predictors of systolic dysfunction were Dip-MBF in the lowest tertile (< 1.1 ml/min/g; relative hazard, 7.5; p = 0.038) and an end-diastolic LV dimension in the highest tertile (> 45 mm; relative hazard, 12.3; p = 0.031).CONCLUSIONS Severe microvascular dysfunction is a potent long-term predictor of adverse LV remodeling and systolic dysfunction in HCM. Our findings indicate microvascular dysfiinction as a potential target for prevention of disease progression and heart failure in HCM.