Key result
In patients with idiopathic dilated cardiomyopathy without overt heart failure, myocardial blood flow reserve was directly related to Doppler-derived dP/dt (r = 0.703, P < 0.0001).
Why the study?
Is myocardial blood flow reserve impairment related to Doppler-derived dP/dt or left ventricular end systolic stress in patients with idiopathic dilated cardiomyopathy without overt heart failure?
Observational (n=26)
Is myocardial blood flow reserve impairment related to Doppler-derived dP/dt or left ventricular end systolic stress in patients with idiopathic dilated cardiomyopathy without overt heart failure?
Effect estimate: r = 0.703
p-value: p=<0.0001
In patients with idiopathic dilated cardiomyopathy without overt heart failure, myocardial blood flow reserve impairment correlates with Doppler-derived dP/dt but not with classical indices of left ventricular function like LVEF.
May link perfusion reserve to early contractility in dilated cardiomyopathy; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Myocardial blood flow during pharmacological vasodilatation is depressed in patients with idiopathic dilated cardiomyopathy even the in absence of overt heart failure; the extent of myocardial blood flow abnormalities is not predictable by left ventricular ejection fraction (LVEF) and diastolic dimensions. AIMS: To assess whether myocardial blood flow impairment in idiopathic dilated cardiomyopathy without overt heart failure can be related to Doppler-derived dP/dt and to echocardiographically determined left ventricular end systolic stress - which is linked to myocardial blood flow reserve in advanced disease. METHODS: Twenty-six patients, New York Heart Association Class I-II, (LVEF 37.4 +/- 1.4%, left ventricular diastolic dimensions 62.6 +/- 0.9 mm) underwent resting/dipyridamole [13N]NH3 flow positron emission tomography and an ultrasonic study. Regional myocardial blood flow values (ml/min per g) were computed from positron emission tomography data in 13 left ventricular (LV) myocardial regions and averaged to provide mean myocardial blood flow and myocardial blood flow reserve, defined as dipyridamole/resting mean myocardial blood flow ratio. RESULTS: Resting myocardial blood flow was 0.686 +/- 0.045, dipyridamole myocardial blood flow 1.39 +/- 0.15 and myocardial blood flow reserve 2.12 +/- 0.2, lower than in controls (P < 0.01). The ratio dP/dt was directly related to dipyridamole myocardial blood flow and myocardial blood flow reserve (r = 0.552 and 0.703, P < 0.005 and P < 0.0001); no relation was found between myocardial blood flow and LVEF left ventricular diastolic dimensions, and left ventricular end systolic stress. CONCLUSIONS: In idiopathic dilated cardiomyopathy patients without overt heart failure, the extent of myocardial blood flow reserve impairment is related to dP/dt but not to more classical indices of left ventricular function.
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Morales et al. (2008) conducted an observational in Idiopathic dilated cardiomyopathy without overt heart failure (n=26). Idiopathic dilated cardiomyopathy without overt heart failure vs. Controls was evaluated on Correlation between Doppler-derived dP/dt and myocardial blood flow reserve (r = 0.703, p=<0.0001). In patients with idiopathic dilated cardiomyopathy without overt heart failure, myocardial blood flow reserve was directly related to Doppler-derived dP/dt (r = 0.703, P < 0.0001).
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