Coronary microvascular ischemia in hypertrophic cardiomyopathy - a pixel-wise quantitative cardiovascular magnetic resonance perfusion study

Journal of Cardiovascular Magnetic Resonance

Research

Anders M Greve¹  Andrew E Arai¹  Li-Yueh Hsu¹  Benjamin Hewins²  Carla Gonçalves²  Ricardo Wage²  Andrew Jabbour²  Ankur Gulati²  Rory O’Hanlon²  Niraj Mistry³  Peter Gatehouse³  Sanjay K Prasad³  David Firmin³  Tevfik F Ismail³  Dudley J Pennell³  Pedro F Ferreira³  Michael Roughton⁴ 

[1] Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA;Cardiovascular Magnetic Resonance and Cardiovascular Biomedical Research Units, Royal Brompton Hospital, London, UK;Cardiovascular Magnetic Resonance and Cardiovascular Biomedical Research Units, Royal Brompton Hospital, London, UK;Imperial College London, London, UK;R-Squared Statistics, London, UK;

关键词: Hypertrophic cardiomyopathy;    Perfusion;    Cardiovascular magnetic resonance;    Microvascular dysfunction;    Sudden cardiac death;   

DOI  :  10.1186/s12968-014-0049-1

 received in 2013-11-17, accepted in 2014-06-20,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMicrovascular dysfunction in HCM has been associated with adverse clinical outcomes. Advances in quantitative cardiovascular magnetic resonance (CMR) perfusion imaging now allow myocardial blood flow to be quantified at the pixel level. We applied these techniques to investigate the spectrum of microvascular dysfunction in hypertrophic cardiomyopathy (HCM) and to explore its relationship with fibrosis and wall thickness.MethodsCMR perfusion imaging was undertaken during adenosine-induced hyperemia and again at rest in 35 patients together with late gadolinium enhancement (LGE) imaging. Myocardial blood flow (MBF) was quantified on a pixel-by-pixel basis from CMR perfusion images using a Fermi-constrained deconvolution algorithm. Regions-of-interest (ROI) in hypoperfused and hyperemic myocardium were identified from the MBF pixel maps. The myocardium was also divided into 16 AHA segments.ResultsResting MBF was significantly higher in the endocardium than in the epicardium (mean ± SD: 1.25 ± 0.35 ml/g/min versus 1.20 ± 0.35 ml/g/min, P < 0.001), a pattern that reversed with stress (2.00 ± 0.76 ml/g/min versus 2.36 ± 0.83 ml/g/min, P < 0.001). ROI analysis revealed 11 (31%) patients with stress MBF lower than resting values (1.05 ± 0.39 ml/g/min versus 1.22 ± 0.36 ml/g/min, P = 0.021). There was a significant negative association between hyperemic MBF and wall thickness (β = −0.047 ml/g/min per mm, 95% CI: −0.057 to −0.038, P < 0.001) and a significantly lower probability of fibrosis in a segment with increasing hyperemic MBF (odds ratio per ml/g/min: 0.086, 95% CI: 0.078 to 0.095, P = 0.003).ConclusionsPixel-wise quantitative CMR perfusion imaging identifies a subgroup of patients with HCM that have localised severe microvascular dysfunction which may give rise to myocardial ischemia.

【 授权许可】

Unknown   
© Ismail et al.;licensee BioMed Central 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.