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Impaired myocardial perfusion in patients with hypertrophic cardiomyopathy: Assessment with digital subtraction coronary arteriography

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Summary

To study the clinical significance of abnormal myocardial perfusion in patients with hypertrophic cardiomyopathy (HCM), we performed a computerized washout analysis of digital subtraction coronary arteriograms in 28 patients with HCM and 16 control subjects. The contrast disappearance half-life (T 1/2) was calculated from a time-density curve generated in the four sectors of the myocardium perfused by the left anterior descending coronary artery and the mean T 1/2 was calculated by averaging T 1/2 values for these four sectors. Patients with HCM demonstrated longer T 1/2 in the ventricular septal region than control subjects. Thirteen (46%) of the patients with HCM presented abnormally longer mean T 1/2 values, suggesting impaired myocardial perfusion. Family histories of HCM were more frequent in patients with abnormal mean T 1/2 values (92% vs 47%;p<0.05). On the exercise stress test, patients with abnormal T 1/2 values presented significantly lower exercise tolerance with more frequent exercise-induced ST segment depression (62% vs 13%;p<0.05). However, there were no significant differences between the two groups with regard to ventricular wall thickness, left ventricular end-diastolic pressure, or the severity of systolic narrowing of the coronary arteries.

These findings suggest that 13 (46%) of the patients with HCM have impaired myocardial perfusion, which may be a manifestation of intramural coronary artery disease in addition to left ventricular hypertrophy, elevated left ventricular end-diastolic pressure, or systolic narrowing of the coronary arteries. Additionally, significant association of the prolonged T 1/2 with a familial occurrence of HCM and depressed exercise tolerance with ST segment depression imply that impaired myocardial perfusion could be an important inherent pathophysiological state leading to myocardial ischemia during exercise.

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Authors and Affiliations

  1. The Third Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, 830, Kurume, Japan

    Hisao Ikeda, Masayoshi Shimamatsu, Osamu Yoshiga, Keigo Shibao & Hironori Toshima

  2. Institute of Cardiovascular Disease, Kurume University School of Medicine, 67 Asahi-machi, 830, Kurume, Japan

    Yoshinori Koga

Authors
  1. Hisao Ikeda
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  2. Masayoshi Shimamatsu
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  3. Osamu Yoshiga
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  4. Keigo Shibao
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  5. Yoshinori Koga
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  6. Hironori Toshima
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This study was supported in part by a Research Grant for Intractable Diseases from the Ministry of Health and Welfare of Japan.

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Ikeda, H., Shimamatsu, M., Yoshiga, O. et al. Impaired myocardial perfusion in patients with hypertrophic cardiomyopathy: Assessment with digital subtraction coronary arteriography. Heart Vessels 4, 170–178 (1988). https://doi.org/10.1007/BF02058430

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  • DOI: https://doi.org/10.1007/BF02058430

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