Coronary Microvascular Dysfunction and Prognosis in Hypertrophic Cardiomyopathy

• Published in: The New England journal of medicine Vol. 349; no. 11; pp. 1027 - 1035
• Main Authors: Cecchi, Franco, Olivotto, Iacopo, Gistri, Roberto, Lorenzoni, Roberto, Chiriatti, Giampaolo, Camici, Paolo G
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 11.09.2003
• Subjects: Adult; Analysis of Variance; Biological and medical sciences; Cardiology. Vascular system; Cardiomyopathy, Hypertrophic - diagnostic imaging; Cardiomyopathy, Hypertrophic - physiopathology; Cardiovascular disease; Cohort Studies; Coronary Circulation - drug effects; Coronary Circulation - physiology; Dipyridamole - pharmacology; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Medical treatment; Microcirculation - drug effects; Microcirculation - physiopathology; Middle Aged; Myocarditis. Cardiomyopathies; Prognosis; Proportional Hazards Models; Risk assessment; Risk Factors; ROC Curve; Survival Analysis; Tomography, Emission-Computed; Ultrasonography; Vasodilator Agents - pharmacology; Human; Prognosis; Pathophysiology; Heart disease; Coronary artery; Hypertrophic cardiomyopathy; Cardiovascular disease; Exploration; Hemodynamics; Myocardial disease; Coronary heart disease; Blood flow
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa025050

Myocardial ischemia due to coronary microvascular dysfunction is believed to occur in patients with hypertrophic cardiomyopathy and may cause clinical events such as sudden death. In this study, coronary microvascular dysfunction was identified with the use of positron-emission tomography before and after the infusion of dipyridamole, a coronary vasodilator. Microvascular dysfunction, defined as an abnormal response to dipyridamole, was associated with an unfavorable outcome, including death from cardiovascular causes. An abnormal response to dipyridamole was associated with an unfavorable outcome. Hypertrophic cardiomyopathy is a genetically determined disease with diverse clinical manifestations and pathophysiological substrates. 1 – 14 Although several factors have been associated with an unfavorable outcome, the identification of patients at risk for sudden death or progression to heart failure remains a formidable challenge. 8 – 11 , 14 , 15 An inadequate increase in myocardial blood flow after intravenous administration of the vasodilator dipyridamole indicates microvascular dysfunction in the absence of coronary stenoses and is detected on positron-emission tomography (PET) in the majority of patients with hypertrophic cardiomyopathy. 16 – 19 Microvascular dysfunction, in turn, represents a predisposing factor for myocardial ischemia, which is also a . . .