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DILATED CARDIOMYOPATHY

Regional coronary flow and contractile reserve in patients with idiopathic dilated cardiomyopathy

Cardiology Department, University Hospital of Heraklion, Heraklion, Greece

Manuscript received May 24, 2004; revised manuscript received July 30, 2004, accepted August 16, 2004.

^* Reprint requests and correspondence: Prof. Panos E. Vardas, Cardiology Dept., Heraklion University Hospital, P.O. Box 1352, 71110 Heraklion, Greece (Email: cardio{at}med.uoc.gr).

OBJECTIVES: The purpose of this study was to assess regional coronary flow and contractile reserve in patients with idiopathic dilated cardiomyopathy (IDCM).

BACKGROUND: Although IDCM has been associated with alterations in coronary blood flow and contractile reserve, little is known about their regional distribution and correlation.

METHODS: Fourteen patients with IDCM and 11 control subjects underwent coronary flow velocity (APV) measurements in the left anterior descending (LAD), left circumflex (LCx), and right coronary (RCA) arteries at baseline (b) and at maximal hyperemia (h). Coronary flow reserve (CFR) was defined as h-APV/b-APV. Wall thickening was assessed in 16 segments (7 assigned to LAD, 5 to LCx, and 4 to RCA) both at rest and under peak stress during low-dose dobutamine echocardiography. Regional contractile reserve was defined as the percentage difference in wall motion score index between rest and stress in each vascular territory.

RESULTS: Although there were no significant differences in b-APV, patients with IDCM had significantly lower h-APV than controls in all three vascular territories and reduced CFR (LAD: 2.79 ± 0.43 vs. 3.48 ± 0.51, p < 0.05; LCx: 2.71 ± 0.39 vs. 3.36 ± 0.65, p < 0.05; and RCA: 3.43 ± 0.55 vs. 4.02 ± 0.73, p < 0.05). There was also a significant correlation between CFR and the corresponding contractile reserve in the vascular territory of the LAD (r = 0.75, p = 0.002) and the LCx (r = 0.64, p = 0.014).

CONCLUSIONS: Patients with IDCM have alterations in regional coronary flow and reduced CFR. Furthermore, the correlation between regional CFR and the corresponding contractile reserve indicates that microvascular dysfunction may have a pathophysiologic role in the evolution of the disease.

Abbreviations and Acronyms   APV = time-averaged peak coronary flow velocity   CFR = coronary flow reserve   IDCM = idiopathic dilated cardiomyopathy   LAD = left anterior descending coronary artery   LCx = left circumflex coronary artery   LV = left ventricle/ventricular   RCA = right coronary artery   WMSI = wall motion score index

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