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Coronary microcirculation changes in non-ischemic dilated cardiomyopathy identified by novel perfusion CT

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Abstract

Intramyocardial microvessels demonstrate functional changes in cardiomyopathies. However, clinical computed tomography (CT) does not have adequate spatial resolution to assess the microvessels. Our hypothesis is that these functional changes manifest as altered heterogeneity of the spatial distribution of arteriolar perfusion territories. Our goal was to determine whether the spatial analysis of perfusion CT could clinically detect changes in the function and structure of the intramyocardial microcirculation in a non-ischemic dilated cardiomyopathy (DCM). Two groups were studied: (1) a Control group (12 male plus 12 female) with no risk factors nor evidence of coronary artery disease, and (2) a DCM group (12 male plus 12 female) with left ventricular ejection fraction ≤40 % and no evidence of coronary artery disease. Using the CT scan, the LV free wall thickness and its radius of curvature were measured. The DCM group was sub divided into those with LV free wall thickness <11.5 mm and those with thickness ≥11.5 mm. In the myocardial opacification phase of the CT scan sequence, myocardial perfusion (F) and intramyocardial blood volume (Bv) for multiple intramyocardial regions were computed. No significant differences between the groups were demonstrable in overall myocardial F or Bv. However, the myocardial regional data showed significantly increased spatial heterogeneity in the DCM group when compared to the Control group. The findings demonstrate that altered function of the subresolution intramyocardial microcirculation can be quantified with myocardial perfusion CT and that significant changes in these parameters occur in the DCM subjects with LV wall thickness greater than 11.5 mm.

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References

  1. Bitar F, Lerman A, Akhter MW, Hatamizadeh P, Janmohamed M, Khan S, Elkayam U (2006) Variable response of conductance and resistance coronary arteries to endothelial stimulation in patients with heart failure due to non-ischemic dilated cardiomyopathy. J Cardiovas Pharm Therap 11:197–202

    Article  CAS  Google Scholar 

  2. Spoladore R, Fisicaro A, Faccini A, Camici PG (2013) Coronary microvascular dysfunction in primary cardiomyopathies. Heart. doi:10.1136/heartjnl-2013-304291

    PubMed  Google Scholar 

  3. Camici PG, Crea F (2007) Coronary microvascular dysfunction. N Engl J Med 356:830–840

    Article  CAS  PubMed  Google Scholar 

  4. Treasure CB, Vita JA, Cox DA, Fish RD, Gordon JB, Mudge GH, Colucci WS, Sutton MG, Selwyn AP, Alexander RW (1990) Endothelium-dependent dilation of the coronary microvasculature is impaired in dilated cardiomyopathy. Circulation 81:772–779

    Article  CAS  PubMed  Google Scholar 

  5. Neglia D, Michelassi C, Trivieri MG, Sambuceti G, Giorgetti A, Pratali L, Gallopin M, Salvadori P, Sorace O, Carpeggiani C, Poddighe R, L’Abbate A, Parodi O (2002) Prognostic role of myocardial blood flow impairment in idiopathic left ventricular dysfunction. Circulation 105:186–193

    Article  PubMed  Google Scholar 

  6. Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG (2003) Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. N Engl J Med 349:1027–1035

    Article  CAS  PubMed  Google Scholar 

  7. Behrenbeck TR, McCollough CH, Miller WL, Williamson EE, Leng S, Kline TL, Ritman EL (2014) Early changes in myocardial microcirculation in asymptomatic hypercholesterolemic subjects: as detected by perfusion CT. Ann Biomed Eng 14(42):515–525

    Article  Google Scholar 

  8. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantitation of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  CAS  PubMed  Google Scholar 

  9. Carlson SK, Felmle JP, Bender CE, Ehman RL, Classic KL, Hu HH, Hoskin TL (2003) Intermittent-mode CT fluoroscopy-guided biopsy of the lung or upper abdomen with breath-hold monitoring and feedback: system development and feasibility. Radiology 229:906–912

    Article  PubMed  Google Scholar 

  10. Rumberger JA, Bell MR, Feiring AJ, Marcus ML, Behrenbeck T, Ritman EL (1991) Measurement of myocardial perfusion using fast computed tomography. In: Marcus M, Schelbert HR, Skorton DJ, Wolf GL (eds) Cardiac imaging: a companion to Braunwald’s Heart Disease. WB Saunders Company, Philadelphia, pp 688–702

    Google Scholar 

  11. Sabiston DC, Gregg DE (1957) Effect of cardiac contraction on coronary blood flow. Circulation 15:14–20

    Article  PubMed  Google Scholar 

  12. Liu YH, Bahn RC, Ritman EL (1992) Dynamic intramyocardial blood volume: evaluation with a radiological opaque marker method. Am J Physiol 263:H963–H967

    CAS  PubMed  Google Scholar 

  13. Mullani N, Gould KL (1983) First pass measurements of regional blood flow using external detectors. J Nucl Med 24(7):577–581

    CAS  PubMed  Google Scholar 

  14. Kanza RE, Higashino H, Kido T, Kurata A, Salto M, Sugawara Y, Mochizuki T (2007) Quantitative assessment of regional left ventricular wall thickness and thickening using 16 multidetector-row computed tomography: comparison with cine magnetic resonance imaging. Radiat Med 25:119–126

    Article  PubMed  Google Scholar 

  15. Basavarajaiah S, Wilson M, Naghavi R, Whyte G, Turner M, Sharma S (2007) Physiological upper limits of left ventricular dimensions in highly trained junior tennis players. Br J Sports Med 41:784–788

    Article  PubMed Central  PubMed  Google Scholar 

  16. Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber qualification: a report from the American Soc of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjuction with the European Association of Echocardiography, branch of the European Soc of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463

    Article  PubMed  Google Scholar 

  17. Thompson HK Jr, Starmer CF, Whalen RE, Mcintosh H (1964) Indicator transit time considered as a gamma variate. Circ Res 14:502–515

    Article  PubMed  Google Scholar 

  18. Daghini E, Primak AN, Chade AR, Zhu X, Ritman EL, McCollough CH, Lerman LO (2007) Evaluation of porcine myocardial microvascular permeability and fractional vascular volume using 64-slice helical computed tomography (CT). Invest Radiol 42:274–282

    Article  PubMed  Google Scholar 

  19. Schmermund A, Bell MR, Lerman LO, Ritman EL, Rumberger JA (1997) Quantitiative evaluation of regional myocardial perfusion using fast X-ray computed tomography. Herz 22(1):29–39

  20. Mohlenkamp S, Beighley PE, Pfeifer EA, Behrnebeck TR, Sheedy PF, Ritman EL (2003) Intramyocardial blood volume, perfusion and transit time in response to embolization of different sized microvessles. Cardiovasc Res 57:843–852

    Article  CAS  PubMed  Google Scholar 

  21. Bassingthwaighte JB, Bever RP (1991) Fractal correlation in heterogeneous systems. Physica D Nonlinear Phenom 53:71–84

    Article  Google Scholar 

  22. NCEP III Guidelines (2001) Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panell III). JAMA 285:2486–2497

    Article  Google Scholar 

  23. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ (2007) Radiation dose to patients from cardiac diagnostic imaging. Circulation 116:1290–1305

    Article  PubMed  Google Scholar 

  24. Ismail TF, Prasad SK, Pennell DJ (2012) Prognostic importance of late gadolinium enhancement cardiovascular magnetic resonance in cardiomyopathy. Heart 98:438–442

    Article  PubMed  Google Scholar 

  25. Ugander U, Oki AJ, Hsu L-Y, Kellman P, Greiser A, Aletras AH, Sibley CT, Chen MY, Bandettini WP, Arai AE (2012) Extracellular volume imaging by magnetic resonance imaging provides insight into overt and subclinical myocardial pathology. Eur Heart J 33:1268–1278

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Malyar NM, Gössl M, Beighley PE, Ritman EL (2004) Relationship between arterial diameter and perfused tissue volume in myocardial microcirculation—a micro-CT based analysis. Am J Physiol Heart Circ Physiol 286:H2386–H2392

    Article  CAS  PubMed  Google Scholar 

  27. Kuo L, David MJ, Chilian WM (1992) Endothelial modulation of arteriolar tone. NIPS 7:5–9

    Google Scholar 

  28. Neglia D, L’Abbate A (2005) Coronary microvascular dysfunction and idiopathic dilated cardiomyopathy. Pharmacol Rep 57(Suppl):151–155

    PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank the following personnel. Dr. Jodie Christner and Ms. Maria Shiung; Study Coordinator, Jennifer Alkhamis; CT Techs—Lisa L. Jorgenson, Emily Sheedy, Katherine Steele, Cynthia Walfoort, Nikkole Weber; CT Nurses—Laurie Claeys, Susan Persons, Susan Inman Radenz and William Stromme; and the Division of Engineering, Aaron Treat, Ms. Renae M. Forsman, Bruce W. Gustine, and Ms. Diane R. Eaker and Delories C. Darling. This study was funded in part by NIH Grants HL72255 and UL1TR000135.

Conflict of interest

The authors do not have any conflict of interest. All co-authors are employed by the Mayo Clinic. The authors have control of the primary data and allow the journal to review their de-identified data if requested.

Ethical standards

The human studies were approved by the Institutional Review Board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

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Authors and Affiliations

  1. Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA

    Wayne L. Miller & Thomas R. Behrenbeck

  2. Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Cynthia H. McCollough, Eric E. Williamson & Shuai Leng

  3. Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Timothy L. Kline & Erik L. Ritman

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  1. Wayne L. Miller
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  2. Thomas R. Behrenbeck
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  3. Cynthia H. McCollough
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  4. Eric E. Williamson
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  5. Shuai Leng
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  6. Timothy L. Kline
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  7. Erik L. Ritman
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Correspondence to Erik L. Ritman.

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Miller, W.L., Behrenbeck, T.R., McCollough, C.H. et al. Coronary microcirculation changes in non-ischemic dilated cardiomyopathy identified by novel perfusion CT. Int J Cardiovasc Imaging 31, 881–888 (2015). https://doi.org/10.1007/s10554-015-0619-9

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  • DOI: https://doi.org/10.1007/s10554-015-0619-9

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