The Research on the Lowering of Coronary Flow Reserve and Smooth Muscle Transformation of Small Coronary Artery in Hypertrophic Cardiomyopathy.

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A) Coronary flow reserve and endothelium-dependent dilator response.The coronary flow reserve, using the papaverine, in the hypertrophic cardiomyopathy (HCM) group lowered clearly in comparison with that of the normal control ( C ) group. (1.8±0.4 and 2.9±0.5, respectively ; p<0.001). The endothelium-dependent dilator response required in the acetylcholine administration was more remarkable loweing over the coronary reserve capacity in the HCM group than that of C group (1.2±0.2, 2.5±0.4, respectively ; p<0.001).B) Pathologic evaluation of the small artery in heart muscle.There was the clear hyperplasia in intima-media complex of intramural small coronary arteries got from myocardial biopasy in the HCM group(%LA=22.4±15.2%). Moreover, there was the remarkable hyperplasy on the circuferencial fibrosis around the small coronary vessel in the HCM group (PFR=5.3±3.1). Though the coronary flow reserve tended to correlate lineally with %LA, and inversely with PFR, anyway not obtained the sig … More nificant correlation either. And, though max %APV and PFR tended to also correlate Inversely, this was not also significant. There is significant positive correlation on %LA with max%APV. Percent increase of coronary blood flow in the high-frequent atrial pacing was more reduced, as the intima-media complex of intramural coronary artery was thicker.C) The transformation of the smooth muscle in intramural coronary artery.The immunostaining was carried out using the monoclonal antibody, and the existence of the transformation of the smooth muscle in the intima-media complex was examined. The Intima-media complex was often covered for the fibrous tissues, and rather the smooth muscle cell often decreased. There was few cases dyed clearly by the immunostaining, and it was not possible to prove the transformation of the smooth muscle clearly. However, is a part of case, there was the transformation mainly on undifferentiated non-muscle myosin(SM emb) in the intima-media complex of the small coronary artery. Less