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Relationship between exercise-induced myocardial ischemia and reduced left ventricular distensibility in patients

Satoshi Isobe1, Hideo Izawa, Yasushi Takeichi

  • 1Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. sisobe@med.nagoya-u.ac.jp

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|November 7, 2003
PubMed

Insights

Myocardial ischemia contributes to reduced left ventricular (LV) diastolic distensibility in hypertrophic cardiomyopathy (HCM) patients. This study clarifies the link between exercise-induced ischemia and impaired LV diastolic function in HCM.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Medical Imaging

Background:

  • Reduced left ventricular (LV) diastolic distensibility is a key factor in hypertrophic cardiomyopathy (HCM) pathophysiology.
  • The precise relationship between myocardial ischemia and impaired LV distensibility in HCM remains incompletely understood.

Purpose of the Study:

  • To investigate the association between exercise-induced myocardial ischemia and reduced LV diastolic distensibility in patients diagnosed with HCM.

Main Methods:

  • Utilized stress-redistribution (201)Tl myocardial scintigraphy, biventricular cardiac catheterization, and echocardiography in 20 HCM patients and 5 controls.
  • Analyzed scintigraphic defects using Berman's 20-segment model, calculating Summed Stress Score (SSS) and Summed Difference Score (SDS).
  • Assessed hemodynamic parameters including LV end-diastolic pressure (LVEDP) and LV pressure half-time during rest and peak exercise.

Main Results:

  • Patients were categorized into ischemic (SSS ≥10, SDS ≥5) and non-ischemic groups.
  • The ischemic HCM group exhibited significantly greater increases in LVEDP and pulmonary artery wedge pressure during exercise compared to the non-ischemic group.
  • The ischemic group showed significantly smaller percentage changes in LV pressure first derivative and LV pressure half-time, indicating impaired diastolic function, without differences in end-diastolic dimensions.

Conclusions:

  • Elevated LVEDP without chamber dilation in some HCM patients signifies reduced LV diastolic distensibility.
  • Exercise-induced myocardial ischemia appears to be a contributing factor to the reduced LV diastolic distensibility observed in HCM.
Abstract

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