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Coronary circulation and myocardial metabolism in dilated cardiomyopathy
Insights
Chest pain in dilated cardiomyopathy (DCMP) may stem from reduced myocardial blood flow and increased lactate production. These findings suggest an anginal origin for chest pain in DCMP patients.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Chest pain is a common symptom in patients diagnosed with dilated cardiomyopathy (DCMP).
- The underlying mechanisms contributing to chest pain in DCMP are not fully understood.
Purpose of the Study:
- To investigate myocardial blood flow, coronary circulation, and coronary sinus lactate levels in patients with DCMP.
- To explore the potential anginal origin of chest pain in DCMP.
Main Methods:
- Measurements included myocardial blood flow, coronary driving pressure, and subendocardial flow index (DPTI/TTI).
- Coronary sinus lactate content was analyzed in 14 DCMP patients and 10 healthy controls.
Main Results:
- Myocardial blood flow was significantly lower in DCMP patients (53.1 ml/min/100 g) compared to controls (66.3 ml/min/100 g).
- Coronary driving pressure and subendocardial flow index were reduced in DCMP.
- Lactate content in coronary sinus blood was elevated in DCMP patients (1.93 mmol/l) versus controls (1.43 mmol/l).
Conclusions:
- Dilated cardiomyopathy is associated with decreased myocardial blood flow.
- Lactate production is common in DCMP patients, indicating myocardial ischemia.
- Chest pain in DCMP is likely of anginal origin due to impaired coronary circulation.
Abstract:
Chest pain is a frequent complaint in patients with dilated cardiomyopathy (DCMP). Myocardial blood flow, coronary circulation parameters and coronary sinus lactate content were measured in 14 patients with DCMP and 10 healthy subjects. Myocardial blood flow in DCMP was 53.1 +/- 3.3 vs. 66.3 +/- 4.9 ml/min/100 g in the control group (p less than 0.05), coronary driving pressure was 59.1 +/- 4.6 vs. 72.8 +/- 8.8 mmHg (p less than 0.01). Subendocardial flow index (DPTI/TTI) in DCMP was 0.76 +/- 0.12 vs. 1.15 +/- 0.19 (p less than 0.01). The lactate content in coronary sinus blood was greater (1.93 +/- 0.45 mmol/l) than in the control group (1.43 +/- 0.48) (p less than 0.05). These results suggest that in DCMP myocardial blood flow is decreased, and in the majority of patients lactate is produced. Thus, it is possible that pain in DCMP is of anginal origin.