Coronary Microcirculation and Left Ventricular Hypertrophy

Abstract

Left ventricular hypertrophy (LVH) is frequently encountered in daily practice representing the macroscopic phenotype of various conditions such as hypertensive heart disease, aortic stenosis, sarcomeric hypertrophic cardiomyopathy (HCM), or infiltrative cardiomyopathies such as cardiac amyloidosis (CA) or Anderson-Fabry disease (AFD). Functional and structural alterations of the coronary microcirculation are widely recognized across the entire spectrum of LVH etiologies. Most frequently, coronary microvascular dysfunction (CMD) in LVH manifests as a low coronary blood flow reserve during vasodilator stress. However, the most dramatic form of CMD is represented by microvascular obstruction (MVO). Among LVH etiologies, MVO has been reported in CA on histology specimens; however, currently there are no reports of MVO diagnosis by non-invasive imaging in CA. The role of cardiovascular magnetic resonance (CMR) in MVO identification is well established in the setting of acute myocardial infarction. We present a case of AL-type CA, in which the diagnosis of MVO is suggested by contrast-enhanced CMR. We take this opportunity to briefly discus the coronary microcirculation alterations in the setting of other LVH etiologies such as sarcomeric HCM or AFD.