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Heart failure and cardiomyopathy
Assessment of intravascular and extravascular mechanisms of myocardial perfusion abnormalities in obstructive hypertrophic cardiomyopathy by myocardial contrast echocardiography
  1. Osama I I Soliman1,
  2. Paul Knaapen2,
  3. Marcel L Geleijnse1,
  4. Pieter A Dijkmans3,
  5. Ashraf M Anwar1,
  6. Attila Nemes1,
  7. Michelle Michels1,
  8. Wim B Vletter1,
  9. Adriaan A Lammertsma2,
  10. Folkert J ten Cate1
  1. 1
    Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
  2. 2
    Department of Nuclear Medicine and Positron Emission Tomography, VU University Medical Centre, Amsterdam, The Netherlands
  3. 3
    Department of Cardiology and Institute of Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands
  1. Dr F J ten Cate, Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, Dr Molewaterplein 40, 3015 GD, Room Ba304, Rotterdam, The Netherlands; f.j.tencate{at}


Objectives: To assess mechanisms of myocardial perfusion impairment in patients with hypertrophic cardiomyopathy (HCM).

Methods: Fourteen patients with obstructive HCM (mean (SD) age 53 (10) years, 11 men) underwent intravenous adenosine myocardial contrast echocardiography (MCE), positron emission tomography (PET) and cardiac catheterisation. Fourteen healthy volunteers (mean age 31 (4) years, 11 men) served as controls. Relative myocardial blood volume (rBV), exchange flow velocity (β), myocardial blood flow (MBF), MBF reserve (MFR) and endocardial-to-subepicardial (endo-to-epi) MBF ratio were measured from the steady state and contrast replenishment time–intensity curves.

Results: Patients with HCM had lower rest MBF (for LVRPP-corrected)—mean (SD) (0.92 (0.12) vs 1.13 (0.25) ml/min/g, p<0.01)—and hyperaemic MBF—(2.56 (0.49) vs 4.34 (0.78) ml/min/g, p<0.01) than controls. Resting rBV was lower in patients with HCM (0.094 (0.016) vs 0.138 (0.014) ml/ml), and during hyperaemia (0.104 (0.018) ml/ml vs 0.185 (0.024) ml/ml) (all p<0.001) than in controls. β tended to be higher in HCM at rest (9.4 (4.6) vs 7.7 (4.2) ml/min) and during hyperaemia (25.8 (6.4) vs 23.1 (6.2) ml/min) than in controls. Septal endo-to-epi MBF decreased during hyperaemia (0.86 (0.15) to 0.64 (0.18), p<0.01). rBV was inversely correlated with left ventricular (LV) mass index (p<0.05). Both hyperaemic and endo-to-epi MBF were inversely correlated with LV end-diastolic pressure, LV mass index, and LV outflow tract pressure gradient (all p<0.05). MCE-derived MBF correlated well with PET at rest (r = 0.84) and hyperaemia (r = 0.87) (all p<0.001).

Conclusions: In patients with HCM, LV end-diastolic pressure, LV outflow tract pressure gradient, and LV mass index are independent predictors of rBV and hyperaemic MBF.

  • myocardial perfusion
  • hypertrophic obstructive cardiomyopathy
  • myocardial contrast echocardiography
  • positron emission tomography

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  • Competing interests: None.

  • Abbreviations:
    hypertrophic cardiomyopathy
    left ventricular
    left ventricular end-diastolic pressure
    left ventricular mass index
    left ventricular outflow tract gradient
    left ventricular rate–pressure product
    myocardial blood flow
    myocardial contrast echocardiography
    myocardial flow reserve
    positron emission tomography
    relative blood volume
    region of interest
    rate–pressure product