Relevance of Coronary Microvascular Flow Impairment to Long-Term Remodeling and Systolic Dysfunction in Hypertrophic Cardiomyopathy
Iacopo Olivotto, MD*,*,
Franco Cecchi, MD*,
Roberto Gistri, MD*,
Roberto Lorenzoni, MD ,
Giampaolo Chiriatti, MD ,
Francesca Girolami, BSc ,
Francesca Torricelli, BSc and
Paolo G. Camici, MD, FACC, FRCP||,¶
* Regional Referral Center for Myocardial Diseases, Florence, Italy
Cytogenetics, Azienda Ospedaliera Careggi, Florence, Italy
Cardiology Unit, Ospedale di Lucca, Lucca, Italy
Cardiology Unit, Ospedale di Pescia, Pescia, Italy
|| Consiglio Nazionale delle Ricerche, Institute of Clinical Physiology, Pisa, Italy
¶ Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, Imperial College, London, United Kingdom
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Figure 1 Comparison of left ventricular (LV) ejection fraction at the time of positron emission tomography (PET) and at final evaluation in the 51 study patients. Vertical bars indicate mean ± SD for each group.
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Figure 2 Stop frames of echocardiograms obtained at the time of the positron emission tomography (PET) scan (age 33 years, panels A, C, and E) and at final evaluation (age 42 years, panels B, D, and F) in a hypertrophic cardiomyopathy (HCM) patient with missense mutations of the myosin beta-heavy chain and of the myosin binding protein C genes (Arg723Cys and Glu165Asp, respectively). Individual measurements are provided in Table 2 (Patient #1). Comparison of the two echocardiograms shows progression of LV cavity enlargement and systolic impairment, with regression of septal hypertrophy. This patient had no functional limitation at the time of PET; over nine years of follow-up he progressively developed congestive symptoms, and at final evaluation he was severely limited, with dyspnea on minimal effort. (A to D) Parasternal long-axis view. (E and F) Apical four-chamber view. *Interventricular septum. LA = left atrium, LV = left ventricle.
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