Pathophysiologic Role of Coronary Microcirculatory Impairment in Dilated Cardiomyopathy
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  and/or in response to either metabolic  or pharmacologic vasodilating stimuli  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.
KeywordsMyocardial Perfusion Dilate Cardiomyopathy Myocardial Blood Flow Coronary Flow Reserve Normal Coronary Artery
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- 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
- 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.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.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.Baroldi G, De Maria R, Silver MD (1996) Pathology of dilated cardiomyopathy of unknown cause. Heart Failure 12:102–110Google Scholar
- 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