Advertisement

Pathophysiologic Role of Coronary Microcirculatory Impairment in Dilated Cardiomyopathy

  • D. Neglia
  • M. Gallopin
  • A. Giorgetti
  • G. Sambuceti
  • M. Bartoli
  • G. Gensini
  • A. L’Abbate
  • O. Parodi
Conference paper

Abstract

Myocardial blood flow (MBF) abnormalities, despite the presence of angiographically normal coronary arteries, have been documented in patients with heart failure due to idiopathic dilated cardiomyopathy (DCM). In particular, a reduction in MBF at rest [1] and/or in response to either metabolic [2] or pharmacologic vasodilating stimuli [3] has been reported. The cause-effect relationship between MBF abnormalities and ventricular dysfunction in DCM, however, is not fully elucidated. An intriguing hypothesis, coming out from the recent recognition of functional abnormalities of the coronary microcirculation in these patients [4–6], points to the relevance of coronary microvascular disease as a primary pathogenetic process leading to progressive ventricular dysfunction. Further testing of this hypothesis implies the demonstration that: 1) in advanced DCM, MBF abnormalities cannot be fully ascribed to the effects of structural and hemodynamic derangement of the myocardium; 2) coronary microvascular dysfunction may be detected also in early stage DCM and may predict progressive deterioration of ventricular function and worse prognosis.

Keywords

Myocardial Perfusion Dilate Cardiomyopathy Myocardial Blood Flow Coronary Flow Reserve Normal Coronary Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Weiss MB, Ellis K, Sciacca RR, Johnson LL, Schmidt DH, Cannon PJ (1976) Myocardial blood flow in congestive and hypertrophic cardiomyopathy. Relationship to peak wall stress and mean velocity of circumferential fiber shortening. Circulation 54:484–493Google Scholar
  2. 2.
    Pasternac A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa MG (1982) Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries. Circulation 65:778–789PubMedCrossRefGoogle Scholar
  3. 3.
    Opherk D, Schwartz F, Mall G, Manthey J, Bailer D, Kubler W (1983) Coronary dilatory capacity in idiopathic dilated cardiomyopathy: analysis of 16 patients. Am J Cardiol 51:1657–1662PubMedCrossRefGoogle Scholar
  4. 4.
    Cannon RO, Cunnion RE, Parrillo JE, Palmen ST, Tucker EE, Schenke WH, Epstein SE (1987) Dynamic limitation of coronary vasodilatory reserve in patients with dilated cardiomyopathy and chest pain. J Am Coll Cardiol 10:1190–1200PubMedCrossRefGoogle Scholar
  5. 5.
    Treasure CB, Vita JA, Cox DA, Fish RD, Gordon JB, Mudge GH, Colucci WS, StJohn Sutton MG, Selwyn AP, Alexander RW, Ganz P (1990) Endothelium-dependent dilation of the coronary microvasculature is impaired in dilated cardiomyopathy. Circulation 81:772–779PubMedCrossRefGoogle Scholar
  6. 6.
    Inoue T, Sakai Y, Morooka S, Hayashi T, Takayanagi K, Yamaguchi H, Kakoi H, Takabatake Y (1994) Vasodilatory capacity of coronary resistance vessels in dilated cardiomyopathy. Am Heart J 127:376–381PubMedCrossRefGoogle Scholar
  7. 7.
    Inoue T, Sakai Y, Morooka S, Hayashi T, Takayanagi K, Yamanaka T, Kakoi H, Takabatake Y (1993) Coronary flow reserve in patients with dilated cardiomypathy. Am Heart J 125:93–98PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson RA, Palacious I (1982) Dilated cardiomyopathies of the adult. N Engl J Med 307:1051–1058PubMedCrossRefGoogle Scholar
  9. 9.
    Nitenberg A, Foult J, Blanchet F, Zouioueche S (1985) Multifactorial determinants of reduced coronary flow reserve after dipyridamole in dilated cardiomyopathy. Am J Cardiol 55:748–754PubMedCrossRefGoogle Scholar
  10. 10.
    Wilson RA, Shea MJ, De Landsheere CM, Turton D, Brady F, Deanfield JE, Selwyn AP (1984) Validation of quantitation of regional myocardial blood flow in vivo with 11C-labeled human albumin microspheres and positron emission tomography. Circulation 70:717–723PubMedCrossRefGoogle Scholar
  11. 11.
    Selwyn AP, Shea MJ., Foale R, Deanfield JE, Wilson R, De Landsheere CM, Turton DL, Brady F, Pike VW, Brookes DI (1986) Regional myocardial and organ blood flow after myocardial infarction: application of the microsphere principle in man. Circulation 73:433–443PubMedCrossRefGoogle Scholar
  12. 12.
    Parodi O, De Maria R, Oltrona L, Testa R, Sambuceti G, Roghi A, Merli M, Berlinghieri L, Accinni R, Spinelli F, Pellegrini A, Baroldi G (1993) Myocardial blood flow distribution in patients with ischemic heart disease or dilated cardiomyopathy undergoing heart transplantation. Circulation 88:509–522PubMedCrossRefGoogle Scholar
  13. 13.
    De Maria R, Parodi O, Baroldi G, Sambuceti G, Testa R, Oltrona L, Grassi M, Parolini M, Barberis M, Sara R, De Vita C, Pellegrini A (1996) Morphological bases for thallium-201 uptake in cardiac imaging and correlates with myocardial blood flow distribution. Eur Heart J 17:951–961PubMedCrossRefGoogle Scholar
  14. 14.
    Accinni R, Belingheri L, Giglioni A, Micelli G, Quaranta M, Wei J, Lucarelli C (1992) Quantitation of collagen/total protein ratio in biological samples by isocratic high performance liquid chromatography 4-hydroxyproline assay. Giorn It Chim Clin 17:27–33Google Scholar
  15. 15.
    Baroldi G, De Maria R, Silver MD (1996) Pathology of dilated cardiomyopathy of unknown cause. Heart Failure 12:102–110Google Scholar
  16. 16.
    Kjekshus JK (1973) Mechanism for flow distribution in normal and ischemic myocardium during increased ventricular preload in the dog. Circ Res 33:490–499CrossRefGoogle Scholar
  17. 17.
    Bergmann SR, Fox KAA, Rand AL, McElvany KD, Welch MJ, Markham MJ, Sobel BE (1984) Quantification of regional myocardial blood flow with H5 15O. Circulation 70:724–733PubMedCrossRefGoogle Scholar
  18. 18.
    Bellina CR, Parodi O, Camici P, Salvadori PA, Taddei L, Fusani L, Guzzardi R, Klassen GA, L’Abbate A, Donato L (1990) Simultaneous in vitro and in vivo validation of 13N-Ammonia for the assessment of regional myocardial blood flow. J Nucl Med 31:1335–1343PubMedGoogle Scholar
  19. 19.
    Neglia D, Parodi O, Gallopin M, Sambuceti G, Giorgetti A, Pratali L, Salvadori P, Michelassi C, Lunardi M, Pelosi G, Marzilli M, L’Abbate A (1995) Myocardial blood flow response to pacing tachycardia and to dipyridamole infusion in patients with dilated cardiomyopathy without overt heart failure. A quantitative assessment by positron emission tomography. Circulation 92:796–804Google Scholar
  20. 20.
    Neglia D, Levorato D, Berti S, Marzilli M, Pelosi G, Marcassa C, Bongiorni MG, L’Abbate A, Contini C (1987) Diagnosi e caratterizzazione funzionale di iniziale danno miocardico in pazienti con aritmie cardiache. Cardiologia 32:713–719PubMedGoogle Scholar
  21. 21.
    Neglia D, Gallopin M, Giorgetti A, Sambuceti G, Schneider-Eicke J, Salvadori P, Simonetti I, L’Abbate A, Parodi P (1997) Function of the adenosine sensitive coronary resistance in patients with mild dilated cardiomyopathy. J Am Coll Cardiol 29:394A (abstr)CrossRefGoogle Scholar
  22. 22.
    Keren A, Popp RL (1992) Assignment of patients into the classification of cardiomyopathies. Circulation 86:1622–1633PubMedCrossRefGoogle Scholar
  23. 23.
    Vaghaiwalla Mody F, Brunken RC, Stevenson LW, Nienaber CA, Phelps ME, Schelbert HR (1991) Differentiating cardiomyopathy of coronary artery disease from nonischemic dilated cardiomyopathy utilizing positron emission tomography. J Am Coll Cardiol 17:373–383CrossRefGoogle Scholar
  24. 24.
    Wallis DE, O’Connel JB, Henkin RE, Costanzo-Nordin MR, Scanion PJ (1984) Segmental wall motion abnormalities in dilated cardiomyopathy: a common finding and good prognostic sign. J Am Coll Cardiol 4:674–679PubMedCrossRefGoogle Scholar
  25. 25.
    Yamaguchi S, Tsuiki K, Hayasaka M, Yasui S (1987) Segmental wall motion abnormalities in dilated cardiomyopathy: hemodynamic characteristics and comparison with thallium-201 myocardial scintigraphy. Am Heart J 113:1123–1128PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • D. Neglia
  • M. Gallopin
  • A. Giorgetti
  • G. Sambuceti
  • M. Bartoli
  • G. Gensini
  • A. L’Abbate
  • O. Parodi

There are no affiliations available

Personalised recommendations