Comparison of Coronary Flow Reserve According to The Degree of Hypokinesia in Dilated Cardiomyopathy With Regional Asynergy

Background and Objectives:Dilated cardiomyopathy (DCMP) is a primary myocardial disease of unknown cause characterized by left ventricular or biventricular dilatation and impaired myocardial been reported in DCMP with generalized hypok contractility. In 1973, Kreulen et al. classified DCMP into two groups-one with generalized hypokinesia and the other with regional asynergy in addition to generalized hypokinesia. Diminished coronary flow reserve has inesia but its mechanism remains obscure. The aim of this study was to investigate the relationship between the degree of microvascular dysfunction and the difference of regional wall motion abnormality in DCMP with regional asynergy. Methods:The subjects of this study were 11 patients (M:F=6:5, mean age:60±15 yrs) a diagnosis of DCMP with regional asynergy, normal sinus rhythm without left bundle branch block and normal coronary angiogram who underwent Doppler wire from September 1997 to December 1999. Left ventricle was divided into three territories according to the coronary arterial distribution by echocardiography (A:coronary artery territory showing regional asynergy, I:coronary artery territory showing intermediate wall motion, P:coronary artery territory showing relatively preserved wall motion). Coronary flow reserve (CFR) was measured at the mid portion of left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) with 0.014 inch Doppler guide wire before and during intracoronary injection of 12-18 μg of adenosine. Relative coronary flow reserve (rCFR) was obtained by the ratio of the CFR in coronary artery of the territory showing regional asynergy and relatively preserved wall motion to the CFR in coronary artery of the territory showing intermediate wall motion (CFRA/CFRI, CFRP/CFRI). Results:Regional asynergy was observed in LAD The mean CFR was 2.5±0.6 in LAD, territory in 4 (36%) patients, LCX territory in 4 (36%) patients, RCA territory in 3 (28%) patients (p=ns).2.4±0.5 in LCX, 2.4±0.6 in RCA (p=ns). The mean CFR and rCFR in coronary arteries showing regional asynergy were significantly lower than those in coronary arteries showing relatively preserved wall motion (2.1±0.5 vs 2.7±0.6, p<0.05, 0.84±0.12 vs 1.11±0.11, p<0.001). 논문접수일:1999년 5월 29일 심사완료일:1999년 9월 25일 교신저자:서정기, 400-103 인천광역시 중구 신흥동 3가 7-206 인하대학교 의과대학 순환기내과학교실 전화:(032) 890-2445·전송:(032) 890-2447 E-mail:jksmd@inha.com