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Effects of alcohol ...
Effects of alcohol septal ablation on coronary microvascular function and myocardial energetics in hypertrophic obstructive cardiomyopathy
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Timmer, Stefan A J (author)
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Knaapen, Paul (author)
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Germans, Tjeerd (author)
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Dijkmans, Pieter A (author)
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- Lubberink, Mark (author)
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam
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Ten Berg, Jurrien M (author)
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Ten Cate, Folkert J (author)
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Rüssel, Iris K (author)
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Götte, Marco J W (author)
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Lammertsma, Adriaan A (author)
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van Rossum, Albert C (author)
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(creator_code:org_t)
- American Physiological Society, 2011
- 2011
- English.
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In: American Journal of Physiology. Heart and Circulatory Physiology. - : American Physiological Society. - 0363-6135 .- 1522-1539. ; 301:1, s. H129-H137
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- This study investigated the effects of alcohol septal ablation (ASA) on microcirculatory function and myocardial energetics in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction. In 15 HCM patients who underwent ASA, echocardiography was performed before and 6 mo after the procedure to assess the LVOT gradient (LVOTG). Additionally, [15O]water PET was performed to obtain resting myocardial blood flow (MBF) and coronary vasodilator reserve (CVR). Changes in LV mass (LVM) and volumes were assessed by cardiovascular magnetic resonance imaging. Myocardial oxygen consumption (MVVo2) was evaluated by [11C]acetate PET in a subset of seven patients to calculate myocardial external efficiency (MEE). After ASA, peak LVOTG decreased from 41 ± 32 to 23 ± 19 mmHg (P = 0.04), as well as LVM (215 ± 74 to 169 ± 63 g; P < 0.001). MBF remained unchanged (0.94 ± 0.23 to 0.98 ± 0.15 ml·min−1·g−1; P = 0.45), whereas CVR increased (2.55 ± 1.23 to 3.05 ± 1.24; P = 0.05). Preoperatively, the endo-to-epicardial MBF ratio was lower during hyperemia compared with rest (0.80 ± 0.18 vs. 1.18 ± 0.15; P < 0.001). After ASA, the endo-to-epicardial hyperemic (h)MBF ratio increased to 1.03 ± 0.26 (P = 0.02). ΔCVR was correlated to ΔLVOTG (r = −0.82; P < 0.001) and ΔLVM (r = −0.54; P = 0.04). MEE increased from 15 ± 6 to 20 ± 9% (P = 0.04). Coronary microvascular dysfunction in obstructive HCM is at least in part reversible by relief of LVOT obstruction. After ASA, hMBF and CVR increased predominantly in the subendocardium. The improvement in CVR was closely correlated to the absolute reduction in peak LVOTG, suggesting a pronounced effect of LV loading conditions on microvascular function of the subendocardium. Furthermore, ASA has favorable effects on myocardial energetics.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)
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Timmer, Stefan A ...
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Knaapen, Paul
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Germans, Tjeerd
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Dijkmans, Pieter ...
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Lubberink, Mark
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Ten Berg, Jurrie ...
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Ten Cate, Folker ...
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Rüssel, Iris K
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Götte, Marco J W
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Lammertsma, Adri ...
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van Rossum, Albe ...
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- MEDICAL AND HEALTH SCIENCES
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Uppsala University