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
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Figure 1 Measurements of CFR
In Patient #1, the thermodilution curves constructed at baseline and during hyperemia nearly overlap. The averaged mean transit time is 0.23 s at baseline and 0.20 s during hyperemia, which is consistent with a severe decrease in CFR. In Patient #2, the duration of the hyperemic thermodilution curve (averaged mean transit time = 0.23 s) is significantly shorter than at baseline (averaged mean transit time = 1.01 s), which is consistent with a normal CFR. CFR = coronary flow reserve.
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Figure 2 Measurement of Capillary Density in Myocardial Biopsy Specimens
Representative photomicrographs of microscopic fields from histological sections of left ventricular myocardium immunochemically stained for CD-34. The slides were photographed at x200, printed on high-quality photographic paper, and stored as 24-bit bitmap files. The immunostained endothelial cells were colored red on the digital images. Microvessels were tagged by the pathologist on the monitor image, and manually counted.
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Figure 3 MCD in Patients With Normal and Low CFR
Shown is the myocardial capillary density (MCD) in patients with heart failure secondary to idiopathic dilated cardiomyopathy (IDC) and normal ( 2.5, column 2) or low (<2.5, column 1) coronary flow reserve (CFR). In column 3, MCD in control patients without heart disease is presented. In IDC patients with normal CFR, MCD was slightly lower, although not significantly different than in normal control patients. In contrast, IDC patients with low CFR had a significantly lower MCD than IDC patients with normal CFR or control patients.
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