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CLINICAL RESEARCH: HEART FAILURE

Depressed Coronary Flow Reserve Is Associated With Decreased Myocardial Capillary Density in Patients With Heart Failure Due to Idiopathic Dilated Cardiomyopathy

Eleftheria P. Tsagalou, MD^_*, Maria Anastasiou-Nana, MD, FESC, Emmanuel Agapitos, MD, Apostolia Gika, MD^_*, Stavros G. Drakos, MD^_*, John V. Terrovitis, MD^_*, Argirios Ntalianis, MD^_* and John N. Nanas, MD, PhD, FESC^_*,_*

^_* Third Cardiology Department, University of Athens School of Medicine, Athens, Greece
Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece
Department of Pathology, University of Athens School of Medicine, Athens, Greece

Manuscript received January 24, 2008; revised manuscript received April 30, 2008, accepted May 27, 2008.

^_* Reprint requests and correspondence: Dr. John N. Nanas, Makedonias 24, 104 33 Athens, Greece (Email: jnanas{at}ath.forthnet.gr).

Objectives: We sought to examine the relationship between coronary flow reserve (CFR) and myocardial capillary density (MCD) in patients with idiopathic dilated cardiomyopathy, heart failure, and normal coronary arteries.

Background: Coronary flow reserve is depressed in patients with idiopathic dilated cardiomyopathy, particularly in those with end-stage congestive heart failure.

Methods: We studied 18 patients, 48 ± 10 years of age, who had a mean New York Heart Association functional class of 2.9 ± 1.3, mean left ventricular ejection fraction of 22 ± 8%, and mean pulmonary capillary wedge pressure of 23 ± 10 mm Hg. CFR measurements were made with a 0.014-inch pressure-temperature sensor-tipped guide wire placed in the distal left anterior descending coronary artery. Thermodilution curves were constructed in triplicate at baseline and during maximum hyperemia induced by intravenous adenosine. CFR was calculated from the ratio of mean transit times. Right heart endomyocardial biopsies were performed during the same procedure. Autopsied specimens from nonfailing hearts were used as controls. The tissue was histochemically stained with CD-34 for morphometric measurements of MCD.

Results: We observed a close linear relationship between CFR and MCD (r = 0.756, p = 0.0001). The MCD in 7 patients with a CFR 2.5 (73.2 ± 16) was similar to that measured in normal control patients, (85 ± 11, p = NS). In contrast, the MCD in 11 patients with a CFR <2.5 was 33.2 ± 14, which was significantly lower than in patients with heart failure and normal CFR (73.2 ± 16, p = 0.001) or in controls (85 ± 11, p < 0.0001).

Conclusions: A marked decrease in MCD was found in patients presenting with congestive heart failure as the result of idiopathic dilated cardiomyopathy and a depressed CFR.

Key Words: cardiomyopathy • heart failure • capillaries • aortic microcirculation

Abbreviations and Acronyms   CFR = coronary flow reserve   CHF = congestive heart failure   FFR = fractional flow reserve   IDC = idiopathic dilated cardiomyopathy   IMR = intramyocardial resistance   LVEDP = left ventricular end-diastolic pressure   MCD = myocardial capillary density   PCWP = pulmonary capillary wedge pressure   VEGF = vascular endothelial growth factor

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