Microvascular Dysfunction in Dilated Cardiomyopathy: A Quantitative Stress Perfusion Cardiovascular Magnetic Resonance Study

This study sought to quantify myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) in dilated cardiomyopathy (DCM) and examine the relationship between myocardial perfusion and adverse left ventricular (LV) remodeling. Although regarded as a nonischemic condition, DCM has been associat...

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Bibliographic Details
Published in:JACC. Cardiovascular imaging Vol. 12; no. 8 Pt 2; p. 1699
Main Authors: Gulati, Ankur, Ismail, Tevfik F, Ali, Aamir, Hsu, Li-Yueh, Gonçalves, Carla, Ismail, Nizar A, Krishnathasan, Kaushiga, Davendralingam, Natasha, Ferreira, Pedro, Halliday, Brian P, Jones, Daniel A, Wage, Ricardo, Newsome, Simon, Gatehouse, Peter, Firmin, David, Jabbour, Andrew, Assomull, Ravi G, Mathur, Anthony, Pennell, Dudley J, Arai, Andrew E, Prasad, Sanjay K
Format: Journal Article
Language:English
Published: United States 01.08.2019
Subjects:
Adult
Cardiomyopathy, Dilated - diagnostic imaging
Cardiomyopathy, Dilated - pathology
Cardiomyopathy, Dilated - physiopathology
Case-Control Studies
Contrast Media - administration & dosage
Coronary Circulation
Female
Fibrosis
Humans
Magnetic Resonance Imaging, Cine
Male
Microcirculation
Middle Aged
Myocardial Perfusion Imaging - methods
Myocardium - pathology
Organometallic Compounds - administration & dosage
Predictive Value of Tests
Prognosis
Prospective Studies
Vasodilator Agents - administration & dosage
Ventricular Dysfunction, Left - diagnostic imaging
Ventricular Dysfunction, Left - pathology
Ventricular Dysfunction, Left - physiopathology
Ventricular Function, Left
Ventricular Remodeling
cardiovascular magnetic resonance imaging
microvascular dysfunction
myocardial blood flow
myocardial perfusion imaging
dilated cardiomyopathy
ISSN:1876-7591, 1876-7591
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Summary:This study sought to quantify myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) in dilated cardiomyopathy (DCM) and examine the relationship between myocardial perfusion and adverse left ventricular (LV) remodeling. Although regarded as a nonischemic condition, DCM has been associated with microvascular dysfunction, which is postulated to play a role in its pathogenesis. However, the relationship of the resulting perfusion abnormalities to myocardial fibrosis and the degree of LV remodeling is unclear. A total of 65 patients and 35 healthy control subjects underwent adenosine (140 μg/kg/min) stress perfusion cardiovascular magnetic resonance with late gadolinium enhancement imaging. Stress and rest MBF and MPR were derived using a modified Fermi-constrained deconvolution algorithm. Patients had significantly higher global rest MBF compared with control subjects (1.73 ± 0.42 ml/g/min vs. 1.14 ± 0.42 ml/g/min; p < 0.001). In contrast, global stress MBF was significantly lower versus control subjects (3.07 ± 1.02 ml/g/min vs. 3.53 ± 0.79 ml/g/min; p = 0.02), resulting in impaired MPR in the DCM group (1.83 ± 0.58 vs. 3.50 ± 1.45; p < 0.001). Global stress MBF (2.70 ± 0.89 ml/g/min vs. 3.44 ± 1.03 ml/g/min; p = 0.017) and global MPR (1.67 ± 0.61 vs. 1.99 ± 0.50; p = 0.047) were significantly reduced in patients with DCM with LV ejection fraction ≤35% compared with those with LV ejection fraction >35%. Segments with fibrosis had lower rest MBF (mean difference: -0.12 ml/g/min; 95% confidence interval: -0.23 to -0.01 ml/g/min; p = 0.035) and lower stress MBF (mean difference: -0.15 ml/g/min; 95% confidence interval: -0.28 to -0.03 ml/g/min; p = 0.013). Patients with DCM exhibit microvascular dysfunction, the severity of which is associated with the degree of LV impairment. However, rest MBF is elevated rather than reduced in DCM. If microvascular dysfunction contributes to the pathogenesis of DCM, then the underlying mechanism is more likely to involve stress-induced repetitive stunning rather than chronic myocardial hypoperfusion.
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ISSN:1876-7591
1876-7591
DOI:10.1016/j.jcmg.2018.10.032