Abnormalities in myocardial contractility, metabolism and perfusion reserve in non-stenotic coronary segments in heart failure patients.

Abstract

OBJECTIVE:

Myocardial blood flow (MBF) reserve is impaired in congestive heart failure (CHF), while fluorine-18-deoxyglucose (18FDG) uptake is relatively preserved. To determine whether this mismatch could be interpreted as ischemia, we performed dobutamine stress echocardiography (DSE).

METHODS:

12 males with coronary artery disease (CAD) and CHF were compared with 12 controls with similar CAD but normal left ventricular (LV) function. MBF in non-infarct-related artery areas was assessed using [(13)N]ammonia positron emission tomography (PET), at rest and after dipyridamole infusion and 18FDG uptake was determined. DSE was performed with doses up to 40 microg/kg per min.

RESULTS:

In areas with non-stenotic arteries MBF reserve was more impaired in CHF patients (1.6+/-0.6 vs. 2.2+/-0.5; CHF versus normal LV, respectively, P<0.05). MBF reserve was related to LV ejection fraction (r=0.6, P<0.05) and wall stress (r=-0.72, P<0.05). PET showed mismatch in 4+/-1% of the myocardium in normal LV, compared to 26+/-26% in CHF (P<0.05), coinciding with more ischemic wall motion abnormalities on DSE (21 vs. 4%; CHF versus normal LV, respectively, P<0.05).

CONCLUSIONS:

In CHF, mismatch was found in areas supplied by non-stenotic coronary arteries. Corresponding areas showed ischemic wall motions on DSE. These findings suggest that the condition of CHF may play a role in perpetuating myocardial failure by inducing myocardial ischemia. Follow-up studies to investigate the ischemia-CHF relationship in time would be needed.

• Authors: Ad F M van den Heuvel, Jeroen J Bax, Paul K Blanksma, Willem Vaalburg, Harry J G M Crijns, Dirk J van Veldhuisen
• Journal: Cardiovascular research (Cardiovasc Res) Vol. 55 Issue 1 Pg. 97-103 (Jul 2002) ISSN: 0008-6363 [Print] England
• PMID: 12062712 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Vasodilator Agents
• Fluorodeoxyglucose F18
• Dipyridamole

Topics

• Aged
• Case-Control Studies
• Coronary Angiography
• Coronary Circulation
• Coronary Disease (diagnostic imaging, metabolism)
• Dipyridamole
• Echocardiography, Stress
• Energy Metabolism
• Fluorodeoxyglucose F18 (pharmacokinetics)
• Heart Failure (diagnostic imaging, metabolism)
• Humans
• Male
• Middle Aged
• Myocardial Contraction
• Myocardial Ischemia (diagnostic imaging, metabolism)
• Myocardium (metabolism)
• Perfusion
• Tomography, Emission-Computed
• Vasodilator Agents