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Regional myocardial blood flow reserve impairment and metabolic changes suggesting myocardial ischemia in patients with idiopathic dilated cardiomyopathy

Ad F. M. van den Heuvel, MD^a, Dirk J. van Veldhuisen, MD, PhD, FACC^a, Ernst E. van der Wall, MD, PhD, FACC^*, Paul K. Blanksma, MD, PhD^a, Hans-Marc J. Siebelink, MD^a, Willem M. Vaalburg, PhD, Wiek H. van Gilst, PhD^a and Harry J. G. M. Crijns, MD, Phd^a

^a Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands
^* Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
National Positron Emission Tomography Center, University Hospital Groningen, Groningen, The Netherlands

View larger version (86K): [in a new window]   Figure 1 Example of PET polar maps. In healthy volunteers (three polar maps at right) MBF reserve (top polar map; 280% = ratio 2.8) and 18FDG uptake (middle polar map; 51 µmol/min per 100 g) are more or less homogeneously distributed throughout the left ventricle. The PET polar maps in a patient with IDC (three polar maps at left) show confluent regions with mismatch (bottom polar map) (i.e., impaired flow reserve [top polar map; mean 210% = ratio 2.1]) paralleled by increased 18FDG uptake (mean 60 µmol/min per 100 g). Flow reserve units are percent hyperemic blood flow related to rest blood flow. Mismatch units are presented as standard deviations of a normal data base. A = anterior; L = lateral; I = inferior; S = septal.

View larger version (18K): [in a new window]   Figure 2 Global myocardial blood flow at rest (dark hatched bars) and after dipyridamole infusion (open bars) in patients with CHF and IDC and in control subjects. #p < 0.05 delta flow in healthy volunteers versus patients with IDC.

View larger version (21K): [in a new window]   Figure 3 Global MBF reserve in control subjects and in patients in New York Heart Association (NYHA) functional classes II and III. *p < 0.05.

View larger version (18K): [in a new window]   Figure 4 Correlation between global MBF during dipyridamole infusion and LV systolic wall stress in patients with IDC.

View larger version (17K): [in a new window]   Figure 5 A, Correlation between global MBF reserve and 11C-acetate clearance rate ratio (ratio of 11C-acetate clearance rates during dobutamine infusion and clearance rates at rest). Note that low dose dobutamine infusion did not exhaust the dipyridamole-determined MBF reserve. B, Correlation between global 11C-acetate clearance rate (kmono = oxygen consumption) at rest and percent myocardium showing mismatch.