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Myocardial blood flow in dilated cardiomyopathy

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Abstract

Myocardial blood flow (MBF) impairment has been documented in advanced idiopathic dilated cardiomyopathy (IDC) where different factors may secondarily affect myocardial perfusion. In failing hearts, explanted from patients with end-stage IDC, MBF is markedly depressed; however, a preferential flow to the subendocardium is preserved; furthermore, the severity of perfusion impairment does not correlate with the extent of fibrosis quantitatively determined by biochemical assessment or evaluated by histologic criteria. Thus, other mechanisms, besides myocardial hemodynamic and structural derangement, seem to operate in determining resting MBF impairment in advanced IDC. Abnormalities in the absolute levels of myocardial perfusion and in regional MBF distribution can also be detected in an early phase of IDC preceeding the development of severe ventricular dysfunction and the clinical appearance of overt heart failure. In patients with subclinical IDC, regional and global myocardial perfusion, as evaluated by positron emission tomography, is frequently impaired both at rest and in response to different vasodilating stimuli such as pacing tachycardia, dipyridamole or adenosine infusion. The presence of an additional coronary resistance, at the microcirculatory level, not sensitive to adenosine, is a possible mechanism causing depressed MBF in subclinical IDC. Progression of the discase is associated with a further impairment in myocardial perfusion.

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Authors and Affiliations

  1. CNR Clinical Physiology Institute, Pisa and Milan, Italy

    Oberdan Parodi, Danilo Neglia & Renata de Maria

  2. Istituto di Clinica Medica Generale e Cardiologia, Universita' di Firenze, Italy

    Michela Gallopin

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Parodi, O., Neglia, D., de Maria, R. et al. Myocardial blood flow in dilated cardiomyopathy. Heart Failure Rev 1, 261–269 (1997). https://doi.org/10.1007/BF00127407

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