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Coronary microvascular dysfunction in hypertrophic cardiomyopathy: Pathophysiology, assessment, and clinical impact

Sílvia Aguiar Rosa1,2, Luís Rocha Lopes3,4,5, António Fiarresga1

  • 1Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal.

Microcirculation (New York, N.Y. : 1994)
|September 8, 2020
PubMed

Insights

Myocardial ischemia in hypertrophic cardiomyopathy causes fibrosis and dysfunction. Evaluating coronary microcirculation indirectly is key for assessing prognosis and risk stratification.

Area of Science:

  • Cardiology
  • Cardiovascular Pathophysiology

Background:

  • Myocardial ischemia is a key feature of hypertrophic cardiomyopathy (HCM).
  • Chronic ischemia contributes to cardiac fibrosis and eventual myocardial dysfunction.
  • Direct visualization of coronary microcirculation in vivo is not feasible.

Purpose of the Study:

  • To highlight the significance of myocardial ischemia in HCM.
  • To discuss indirect methods for evaluating coronary microcirculation.
  • To emphasize the role of microcirculatory dysfunction in risk stratification.

Main Methods:

  • Indirect evaluation of coronary microcirculation using echocardiography, magnetic resonance, positron emission tomography, and cardiac catheterization.
  • Assessment of myocardial blood flow and coronary flow reserve.

Main Results:

  • Blunted myocardial blood flow and coronary flow reserve are linked to poorer prognosis.
  • Microcirculatory dysfunction is a significant finding in HCM patients.

Conclusions:

  • Microcirculatory dysfunction is a crucial pathophysiological aspect of HCM.
  • Assessing microcirculatory function provides valuable prognostic information.
  • Microcirculatory dysfunction may enhance risk stratification beyond traditional factors in HCM.

Keywords:
hypertrophic cardiomyopathymicrocirculatory dysfunction

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