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Myocardial perfusion reserve and peripheral endothelial function in patients with idiopathic dilated cardiomyopathy
Kira Q Stolen1, Jukka Kemppainen, Kari K Kalliokoski
1Turku PET Centre, Turku, Finland.
Insights
Patients with idiopathic dilated cardiomyopathy (IDC) show impaired myocardial perfusion reserve, but their peripheral endothelial function remains normal. Peripheral endothelial function and heart function do not correlate in IDC patients.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Idiopathic dilated cardiomyopathy (IDC) is a common cause of heart failure.
- Peripheral endothelial dysfunction is often observed in heart failure patients.
- The relationship between peripheral endothelial function and myocardial perfusion reserve in mild IDC is not well understood.
Purpose of the Study:
- To investigate the association between peripheral endothelial function and myocardial perfusion reserve in patients with mild IDC.
- To compare these parameters between IDC patients and healthy controls.
Main Methods:
- Positron emission tomography (PET) with oxygen-15-labeled water was used to measure myocardial perfusion at rest and during pharmacologic hyperemia (dipyridamole).
- Perfusion reserve was calculated as the ratio of hyperemic to resting perfusion.
- Brachial artery flow-mediated dilation (FMD) was assessed to evaluate peripheral endothelial function.
Main Results:
- Patients with IDC exhibited significantly lower hyperemic myocardial perfusion and perfusion reserve compared to healthy subjects.
- Brachial artery FMD was comparable between IDC patients and healthy controls.
- No correlation was found between FMD and myocardial perfusion reserve in IDC patients, unlike in healthy subjects.
Conclusions:
- Abnormal myocardial perfusion reserve is a characteristic finding in patients with mild IDC.
- Peripheral endothelial function and myocardial perfusion reserve do not run in parallel in patients with IDC.
- These findings suggest distinct pathophysiological mechanisms affecting central and peripheral vasculature in IDC.
Abstract:
The aim of this study was to assess the relation between peripheral endothelial function and myocardial perfusion reserve in patients with mild heart failure due to idiopathic dilated cardiomyopathy (IDC). Myocardial perfusion and brachial artery flow mediated dilation (FMD) were measured in 20 clinically stable patients with IDC (New York Heart Association classes I to III, ejection fraction 35 +/- 9%) and 13 apparently healthy subjects who were matched for age and lipid profile. Resting and hyperemic (dipyridamole; 0.56 mg/kg/min) perfusion were measured using oxygen-15-labeled water and positron emission tomography (PET). Perfusion reserve was calculated as the ratio of hyperemic to resting perfusion. FMD was assessed by measuring the change in brachial artery diameter in response to reactive hyperemia. Patients with IDC had lower hyperemic perfusion (1.73 +/- 0.83 vs 3.01 +/- 1.20 ml/min/g, p <0.001) and perfusion reserve (2.01 +/- 0.91 vs 3.08 +/- 1.35, p <0.01) compared with healthy subjects. Brachial artery FMD, however, was not different from that of the healthy subjects. Furthermore, neither hyperemic perfusion nor perfusion reserve was correlated with FMD in the patients with IDC, whereas the healthy subjects demonstrated a positive correlation between FMD and perfusion reserve (r = 0.57; p = 0.04). Thus, abnormal myocardial perfusion characterizes patients with IDC. Myocardial perfusion reserve and peripheral endothelial function do not parallel each other in patients with IDC.
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