Coronary Microvascular Dysfunction Is Related to Abnormalities in Myocardial Structure and Function in Cardiac Amyloidosis

Abstract Objectives The purpose of this study was to test the hypothesis that coronary microvascular function is impaired in subjects with cardiac amyloidosis. Background Effort angina is common in subjects with cardiac amyloidosis, even in the absence of epicardial coronary artery disease (CAD). Me...

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Bibliographic Details
Published in:JACC. Heart failure 2014-08, Vol.2 (4), p.358-367
Main Authors: Dorbala, Sharmila, MD, Vangala, Divya, MA, Bruyere, John, MA, Quarta, Christina, MD, Kruger, Jenna, BS, Padera, Robert, MD, Foster, Courtney, MSc, CNMT, Hanley, Michael, MD, Di Carli, Marcelo F., MD, Falk, Rodney, MD
Format: Article
Language:English
Subjects:
amyloidosis
Amyloidosis - pathology
Amyloidosis - physiopathology
Blood Flow Velocity - physiology
Cardiomyopathies - pathology
Cardiomyopathies - physiopathology
Cardiovascular
Coronary Circulation - physiology
coronary microvascular function
Coronary Vessels - physiology
Electrocardiography
Female
Humans
Hyperemia - pathology
Hyperemia - physiopathology
Hypertrophy, Left Ventricular - physiopathology
Male
Microvessels - physiology
Middle Aged
myocardial blood flow
Myocardium - pathology
PET
Positron-Emission Tomography
Prospective Studies
strain
Tomography, X-Ray Computed
Vasomotor System - physiology
Ventricular Dysfunction, Left - pathology
Ventricular Dysfunction, Left - physiopathology
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Summary:Abstract Objectives The purpose of this study was to test the hypothesis that coronary microvascular function is impaired in subjects with cardiac amyloidosis. Background Effort angina is common in subjects with cardiac amyloidosis, even in the absence of epicardial coronary artery disease (CAD). Methods Thirty-one subjects were prospectively enrolled in this study, including 21 subjects with definite cardiac amyloidosis without epicardial CAD and 10 subjects with hypertensive left ventricular hypertrophy (LVH). All subjects underwent rest and vasodilator stress N-13 ammonia positron emission tomography and 2-dimensional echocardiography. Global left ventricular myocardial blood flow (MBF) was quantified at rest and during peak hyperemia, and coronary flow reserve (CFR) was computed (peak stress MBF/rest MBF) adjusting for rest rate pressure product. Results Compared with the LVH group, the amyloid group showed lower rest MBF (0.59 ± 0.15 ml/g/min vs. 0.88 ± 0.23 ml/g/min; p = 0.004), stress MBF (0.85 ± 0.29 ml/g/min vs. 1.85 ± 0.45 ml/g/min; p < 0.0001), and CFR (1.19 ± 0.38 vs. 2.23 ± 0.88; p < 0.0001) and higher minimal coronary vascular resistance (111 ± 40 ml/g/min/mm Hg vs. 70 ± 19 ml/g/min/mm Hg; p = 0.004). Of note, almost all subjects with amyloidosis (>95%) had significantly reduced peak stress MBF (
ISSN:2213-1779
2213-1787
DOI:10.1016/j.jchf.2014.03.009