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Left Ventricular Diastolic Function and Myocardial Ischemia in Hypertrophic Cardiomyopathy: Assessment by Radionuclide Methods

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Advances in Cardiomyopathies

Abstract

Impaired diastolic function of the hypertrophied and stiffened left ventricle is a characteristic feature of hypertrophic cardiomyopathy [1–9]. The pathophysiologic basis and clinical significance of altered diastolic performance in this condition has been the subject of intense interest and investigation for the past two decades. Altered left ventricular filling dynamics and reduced left ventricular distensibility are associated with reduced left ventricular stroke volume, increased left ventricular filling pressures, and compressive effects on the coronary microcirculation. These factors contribute importantly to the clinical presentation of many patients, including symptoms of fatigue, dyspnea, and angina pectoris. Abnormal diastolic function has been demonstrated in the vast majority of patients with hypertrophic cardiomyopathy undergoing hemodynamic or noninvasive studies (Fig. 1.) [1–9]. This review will focus on the assessment of left ventricular diastolic function in hypertrophic cardiomyopathy, and the interplay between altered diastolic function and myocardial ischemia, using data derived from radionuclide techniques applied both in the noninvasive laboratory and in the catheterization laboratory.

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References

  1. Sanderson JE, Gibson DG, Brown DJ, Goodwin JF (1977) Left ventricular filling in hypertrophic cardiomyopathy: an angiographic study. Br Heart J 39: 661–670

    Article  PubMed  CAS  Google Scholar 

  2. Sanderson JE, Traill TA, St John Sutton MG, Brown DJ, Gibson DG, Goodwin JF (1978) Left ventricular relaxation and filling in hypertrophic cardiomyopathy: an echocardiographic study. Br Heart J 40: 596–601

    Article  PubMed  CAS  Google Scholar 

  3. St John Sutton MG, Tajik AJ, Gibson DG, Brown CJ, Seward JB, Giuliani ER (1978) Echocardiographic assessment of left ventricular filling and septal and posterior wall dynamics in idiopathic hypertrophic subaortic stenosis. Circulation 57: 512–520

    Google Scholar 

  4. Hanrath P, Mathey DG, Siegert R, Bleifeld W (1980) Left ventricular relaxation and filling in different forms of left ventricular hypertrophy: an echocardiographic study. Am J Cardiol 45: 15–23

    Article  PubMed  CAS  Google Scholar 

  5. Bonow RO, Rosing DR, Bacharach SL, Green MV, Kent KM, Lipson LC, Maron BJ, Leon MB, Epstein SE (1981) Effect of verapamil on left ventricular systolic function and diastolic filling in patients with hypertrophic cardiomyopathy. Circulation 64: 787–796

    Article  PubMed  CAS  Google Scholar 

  6. Bonow RO, Frederick TM, Bacharach SL, Green MV, Goose PW, Maron BJ, Rosing DR (1983) Atrial systole and left ventricular filling in patients with hypertrophic cardiomyopathy: effect of verapamil. Am J Cardiol 51: 1386–1391

    Article  PubMed  CAS  Google Scholar 

  7. Alvares RF, Shaver JA, Gamble WH, Goodwin JF (1984) Isovolumic relaxation period in hypertrophic cardiomyopathy. J Am Coll Cardiol 3: 71–81

    Article  PubMed  CAS  Google Scholar 

  8. Betocchi S, Bonow RO, Bacharach SL, Rosing DR, Maron BJ, Green MV (1986) Isovolumic relaxation period in hypertrophic cardiomyopathy: assessment by radionuclide angiography. J Am Coll Cardiol 7: 74–81

    Article  PubMed  CAS  Google Scholar 

  9. Maron BJ, Spirito P, Green KJ, Wesley YE, Bonow RO, Arce J (1987) Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 10: 733–742

    Article  PubMed  CAS  Google Scholar 

  10. Gaasch WH, Levine HJ, Quinones MA, Alexander JK (1976) Left ventricular compliance: mechanisms and clinical implications. Am J Cardiol 38: 645–653

    Article  PubMed  CAS  Google Scholar 

  11. Grossman W, Barry WH (1980) Diastolic pressure-volume relations in the diseased heart. Fed Proc 39: 148–155

    PubMed  CAS  Google Scholar 

  12. Gaasch WH, Cole JS, Quinones MA, Alexander JK (1975) Dynamic determinants left ventricular pressure-volume relations in man. Circulation 51: 317–323

    PubMed  CAS  Google Scholar 

  13. Bonow RO (1987) Left ventricular filling in ischemic and hypertrophic heart disease. In: Grossman W, Lorell BH (eds) Diastolic relaxation of the heart. Nijhoff, Boston, pp 231–243

    Google Scholar 

  14. Sordahl LA, McCollum WB, Wood WG, Schwartz A (1973) Mitochondria and sarco-plasmic reticulum function in cardiac hypertrophy and failure. Am J Physiol 224: 497–502

    PubMed  CAS  Google Scholar 

  15. Ito Y, Suko J, Chidsey CA (1974) Intracellular calcium and myocardial contractility. V. Calcium uptake of sarcoplasmic reticulum fractions in hypertrophied and failing rabbit hearts. J Mol Cell Cardiol 6: 237–247

    Article  PubMed  CAS  Google Scholar 

  16. Lecarptenier Y, Martin L, Gastineau P, Hatt PY (1982) Load dependence of mammalian heart relaxation during cardiac hypertrophy and failure. Am J Physiol 242: H855–861

    Google Scholar 

  17. Gwathmey JK, Morgan JP (1985) Altered calcium handling in experimental pressure-overload hypertrophy in the ferrec. Circ Res 57: 836–843

    PubMed  CAS  Google Scholar 

  18. Gwathmey JK, Copelas L, MacKinnon R, Schoen FJ, Feldman MD, Grossman W, Morgan JP (1987) Abnormal intracellular calcium handling in myocardium from patients with end-stage heart failure. Circ Res 61: 70–76

    PubMed  CAS  Google Scholar 

  19. Wagner JA, Sax FL, Weisman HF, Portersfield J, Mcintosh CL, Weisfeldt ML, Snyder SH, Epstein SE (1989) Calcium antagonist receptors are selectively increased in atrial tissue of patients with hypertrophic cardiomyopathy. N Engl J Med 320: 755–761

    Article  PubMed  CAS  Google Scholar 

  20. Pasternac A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa MG (1982) Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries. Circulation 65: 778–798

    Article  PubMed  CAS  Google Scholar 

  21. Cannon RO, Rosing DR, Maron BJ, Leon MB, Bonow RO, Watson RM, Epstein SE (1985) Myocardial ischemia in patients with hypertrophic cardiomyopathy: contribution of inadequate vasodilator reserve and elevated left ventricular filling pressures. Circulation 71: 234–243

    Article  PubMed  Google Scholar 

  22. O’Gara PT, Bonow RO, Maron BJ, Damske BA, Van Lingen A, Bacharach SL, Larson SM, Epstein SE (1987) Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography. Circulation 76: 1214–1223

    Article  PubMed  Google Scholar 

  23. Henry PD, Schuchleib R, David J, Weiss ES, Sobel BE (1977) Myocardial contracture and accumulation of mitochondrial calcium in ischemic rabbit heart. Am J Physiol 233: H677–684

    PubMed  CAS  Google Scholar 

  24. Nayler WG, Williams A (1978) Relaxation in heart muscle: Some morphologic and biochemical considerations. Eur J Cardiol 7 (suppl): 35–50

    PubMed  Google Scholar 

  25. Nayler WG, Poole-Wilson PA, Williams A (1979) Hypoxia and calcium. J Mol Cell Cardiol 11: 683–706

    Article  PubMed  CAS  Google Scholar 

  26. Mann T, Goldberg S, Mudge GH, Grossman W (1979) Factors contributing to altered left ventricular diastolic properties during angina pectoris. Circulation 59: 14–20

    PubMed  CAS  Google Scholar 

  27. Paulus WJ, Serizawa T, Grossman W (1982) Altered left ventricular diastolic properties during pacing-induced ischemia in dogs with coronary stenoses: potentiation by caffeine. Circ Res 50: 218–227

    PubMed  CAS  Google Scholar 

  28. Carroll JD, Hess OM, Hirzel HO, Krayenbuehl HP (1983) Exercise-induced ischemia: the influence of altered relaxation on early diastolic pressures. Circulation 67: 521–528

    Article  PubMed  CAS  Google Scholar 

  29. Lorell BH, Wexler LF, Momomura S, Weinberg E, Apstein CS (1986) The influence of pressure hypertrophy on diastolic properties during hypoxia in isovolumically contracting rat hearts. Circ Res 58: 653–663

    PubMed  CAS  Google Scholar 

  30. Wexler LF, Lorell BH, Monomura S, Weinberg EO, Ingwall JS, Apstein CS (1988) Enhanced sensitivity to hypoxia-induced diastolic dysfunction in pressure-overload left ventricular hypertrophy in the rat: role of high energy phosphate depletion. Circ Res 62: 766–775

    PubMed  CAS  Google Scholar 

  31. Brutsaert DL, Housmans PR, Goethals MA (1980) Dual control of relaxation: its role in the ventricular function in the mammalian heart. Circ Res 47: 637–652

    PubMed  CAS  Google Scholar 

  32. Brutsaert DL, Rademakers FE, Sys US (1983) Triple control of relaxation: implications in cardiac disease. Circulation 69: 190–196

    Article  Google Scholar 

  33. Gaasch WH, Blaustein AS, Andrias CW, Donahue RP, Avitall B (1980) Myocardial relaxation. II. Hemodynamic determinants of rate of left ventricular pressure decline. Am J Physiol 239:Hl–6

    Google Scholar 

  34. Pouleur H, Rousseau MF, van Eyll C, Brasseur LA, Charlier A A (1983) Force-velocity- length relations in hypertrophic cardiomyopathy: evidence for normal or depressed myocardial contractility. Am J Cardiol 52: 813–817

    Article  PubMed  CAS  Google Scholar 

  35. Blaustein AS, Gaasch WH (1983) Myocardial relaxation. VI. Effects of beta-adrenergic tone and asynchrony on LV relaxation rate. Am J Physiol 244: H417–122

    PubMed  CAS  Google Scholar 

  36. Brutsaert DL (1987) Nonuniformity: a physiologic modulator of contraction and relaxation of the normal heart. J Am Coll Cardiol 9: 341–348

    Article  PubMed  CAS  Google Scholar 

  37. Zile MR, Blaustein AS, Shimizu G, Gaasch WH (1987) Right ventricular pacing reduces the rate of left ventricular relaxation and filling. J Am Coll Cardiol 10: 702–709

    Article  PubMed  CAS  Google Scholar 

  38. Bonow RO (1990) Regional left ventricular nonuniformity: effects on left ventricular diastolic function in ischemic heart disease, in hypertrophic cardiomyopathy, and in the normal heart. Circulation (in press)

    Google Scholar 

  39. Bonow RO, Vitale DF, Maron BJ, Bacharach SL, Frederick TM, Green MV (1987) Regional left ventricular asynchrony and impaired global ventricular filling in hypertrophic cardiomyopathy: effect of verapamil. J Am Coll Cardiol 9: 1108–1116

    Article  PubMed  CAS  Google Scholar 

  40. Hanrath P, Mathey DG, Kremer P, Sonntag F, Bleifeld W (1980) Effect of verapamil on left ventricular isovolumic relaxation time and regional left ventricular filling in hyper-trophic cardiomyopathy. Am J Cardiol 45: 1258–1264

    Article  PubMed  CAS  Google Scholar 

  41. Lorell BH, Paulus WJ, Grossman W, Wynne J, Cohn PF (1982) Modification of abnormal left ventricular diastolic properties by nifedipine in patients with hypertrophic cardiomyopathy. Circulation 65: 499–507

    Article  PubMed  CAS  Google Scholar 

  42. Paulus WJ, Lorell BH, Craig WE, Wynne J, Murgo JP, Grossman W (1983) Comparison of the effects of nitroprusside and nifedipine on diastolic properties in patients with hypertrophic cardiomyopathy: altered left ventricular loading or impaired muscle inactivation? J Am Coll Cardiol 2: 879–886

    Article  PubMed  CAS  Google Scholar 

  43. Bonow RO, Ostrow HG, Rosing DR, Cannon RO, Lipson LW, Maron BJ, Kent KM, Bacharach SL, Green MV (1983) Effects of verapamil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy: pressure-volume analysis with a nonimaging scintillation probe. Circulation 68: 1062–1073

    Article  PubMed  CAS  Google Scholar 

  44. Hanrath P, Schlüter M, Sonntag F, Diemert J, Bleifeld W (1983) Influence of verapamil therapy on left ventricular performance at rest and during exercise in hypertrophic cardiomyopathy. Am J Cardiol 52: 544–548

    Article  PubMed  CAS  Google Scholar 

  45. Suwa M, Hirota Y, Kawamura K (1984) Improvement in left ventricular diastolic function during intravenous and oral diltiazem therapy in patients with hypertrophic cardiomyopathy: an echocardiographic study. Am J Cardiol 54: 1047–1053

    Article  PubMed  CAS  Google Scholar 

  46. Bonow RO, Dilsizian V, Rosing DR, Maron BJ, Bacharach SL, Green MV (1985) Verapamil-induced improvement in left ventricular diastolic filling and increased exercise tolerance in patients with hypertrophic cardiomyopathy: short- and long-term effects. Circulation 72: 853–864

    Article  PubMed  CAS  Google Scholar 

  47. Bonow RO (1985) Effect of calcium channel blocking agents on left ventricular diastolic function in hypertrophic cardiomyopathy and in coronary artery disease. Am J Cardiol 55: 172B–178B

    Article  PubMed  CAS  Google Scholar 

  48. Hess OM, Murakami T, Krayenbuehl HP (1986) Does verapamil improve left ventricular relaxation in patients with myocardial hypertrophy? Circulation 74: 530–543

    Article  PubMed  CAS  Google Scholar 

  49. Iwase M, Sotobata I, Takagi S, Miyaguchi K, Jing HX, Yokota M (1987) Effects of diltiazem on left ventricular diastolic behavior in patients with hypertrophic cardiomyopathy: evaluation with exercise pulsed Doppler echocardiography. J Am Coll Cardiol 9: 1099–1105

    Article  PubMed  CAS  Google Scholar 

  50. Speiser KW, Krayenbuehl HP (1981) Reappraisal of the effect of acute beta blockade on left ventricular filling dynamics in hypertrophic obstructive cardiomyopathy. Eur Heart J 2: 21–29

    PubMed  CAS  Google Scholar 

  51. Betocchi S, Cannon RO, Watson RM, Bonow RO, Ostrow HG, Epstein SE, Rosing DR (1985) Effects of sublingual nifedipine on hemodynamics and systolic and diastolic function in patients with hypertrophic cardiomyopathy. Circulation 72: 1001–1007

    Article  PubMed  CAS  Google Scholar 

  52. Rosing DR, Kent KM, Borer JS, Seides SF, Maron BJ, Epstein SE (1979) Verapamil therapy: a new approach to the pharmacologic treatment of hypertrophic cardiomyopathy. I. Hemodynamic effects. Circulation 60: 1201–1207

    CAS  Google Scholar 

  53. Walsh RA, O’Rourke RA (1985) Direct and indirect effects of calcium entry blocking agents on isovolumic relaxation in conscious dogs. J Clin Invest 75: 1426–1434

    Article  PubMed  CAS  Google Scholar 

  54. Udelson JE, Bonow RO, O’Gara PT, Maron BJ, Van Lingen A, Bacharach SL, Epstein SE (1989) Verapamil prevents silent myocardial perfusion abnormalities during exercise in asymptomatic patients with hypertrophic cardiomyopathy. Circulation 79: 371–382

    Article  PubMed  CAS  Google Scholar 

  55. Maron BJ, Epstein SE, Roberts WC (1979) Hypertrophic cardiomyopathy and transmural myocardial infarction without significant atherosclerosis of the extramural coronary arteries. Am J Cardiol 43: 1086–1102

    Article  PubMed  CAS  Google Scholar 

  56. St John Sutton MG, Lie JT, Anderson KR, O’Brien PC, Frye RL (1980) Histologic specificity of hypertrophic obstructive cardiomyopathy: myocardial fiber disarray and myocardial fibrosis. Br Heart J 44: 433–143

    Article  PubMed  CAS  Google Scholar 

  57. Rubin KA, Morrison J, Padrick MB, Binder AJ, Chiaramide S, Margouleff D, Padmanabhan VT, Gulotta SJ (1979) Idiopathic hypertrophic subaortic stenosis: evaluation of anginal symptoms with thallium-201 myocardial imaging. Am J Cardiol 44: 1040–1045

    Article  PubMed  CAS  Google Scholar 

  58. Pitcher D, Wainwright R, Maisey M, Curry P, Lowton E (1980) Assessment of chest pain in hypertrophic cardiomyopathy using exercise thallium-201 myocardial scintigraphy. Br Heart J 44: 650–656

    Article  PubMed  CAS  Google Scholar 

  59. Hanrath P, Matthey D, Montz R, Thiel V, Vorbringer H, Kupper W, Schneider C, Bleifeld W (1981) Myocardial thallium-201 imaging in hypertrophic obstructive cardiomyopathy. Eur Heart J 2: 177–185

    PubMed  CAS  Google Scholar 

  60. Nagata S, Park V-D, Nininikawa T, Yutani C, Kamiya T, Nishimura T, Kozuka T, Sakakibara H, Nimura Y (1985) Thallium perfusion and cardiac enzyme abnormalities in patients with familial hypertrophic cardiomyopathy. Am Heart J 109: 1317–1322

    Article  PubMed  CAS  Google Scholar 

  61. O’Gara PT, Bonow RO, Maron BJ, Damske BA, Van Lingen A, Bacharach SL, Larson SM, Epstein SE (1987) Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography. Circulation 76: 1214–1223

    Article  PubMed  Google Scholar 

  62. ten Cate FJ, Roelandt J (1979) Progression to left ventricular dilatation in patients with hypertrophic obstructive cardiomyopathy. Am Heart J 97: 762–765

    Article  PubMed  Google Scholar 

  63. Ciro E, Maron BJ, Bonow RO, Cannon RO, Epstein SE (1984) Relation between marked changes in outflow tract gradient and disease progression in patients with hypertrophic cardiomyopathy. Am J Cardiol 53: 1103–1109

    Article  PubMed  CAS  Google Scholar 

  64. Spirito P, Maron BJ, Bonow RO, Epstein SE (1986) Severe functional limitation in patients with hypertrophic cardiomyopathy and only mild localized left ventricular hypertrophy. J Am Coll Cardiol 8: 537–544

    Article  PubMed  CAS  Google Scholar 

  65. Spirito P, Maron BJ, Bonow RO, Epstein SE (1987) Occurrence and significance of progressive left ventricular wall thinning and relative cavity dilatation in patients with hypertrophic cardiomyopathy. Am J Cardiol 60: 123–129

    Article  PubMed  CAS  Google Scholar 

  66. Udelson JE, Maron BJ, O’Gara PT, Bonow RO (1989) Relation between left ventricular hypertrophy, filling, and perfusion in asymptomatic hypertrophic cardiomyopathy. J Am Coll Cardiol 13: 80A (abst)

    Google Scholar 

  67. Bonow RO, Mar on BJ, Leon MB, Cannon RO, Epstein SE (1988) Medical and surgical therapy of hypertrophic cardiomyopathy. In: Shaver J A (ed) Cardiomyopathies: clinical presentation, differential diagnosis, and management. Davies, Philadelphia, pp 221–239

    Google Scholar 

  68. Marcus ML, Doty DB, Hiratzka LF, Wright CB, Eastham CL (1982) Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med 307: 1362–1366

    Article  PubMed  CAS  Google Scholar 

  69. Opherk D, Mall G, Zebe H, Schwarz F, Weihe E, Manthey J, Kubler W (1984) Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries. Circulation 69: 1–7

    Article  PubMed  CAS  Google Scholar 

  70. James TH, Marshall TK (1975) De subitaneis mortibus. XII. Asymmetrical hypertrophy of the heart. Circulation 51: 1149–1166

    PubMed  CAS  Google Scholar 

  71. Maron BJ, Wolfson JK, Epstein SE, Roberts WC (1986) Intramural (“small vessel”) coronary artery disease in hypertrophic cardiomyopathy. J Am Coll Cardiol 8: 545–557

    Article  PubMed  CAS  Google Scholar 

  72. Morad M, Rolett EL (1972) Relaxing effects of catecholamines on mammalian heart. J Physiol (Lond) 224: 537–558

    CAS  Google Scholar 

  73. Udelson JE, Cannon RO, Bacharach SL, Rumble TF, Bonow RO (1989) Beta-adrenergic stimulation with isoproterenol enhances left ventricular diastolic performance in hypertrophic cardiomyopathy despite potentiation of myocardial ischemia: comparison to rapid atrial pacing. Circulation 79: 371–382

    Article  PubMed  CAS  Google Scholar 

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  1. R. O. Bonow
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Editors and Affiliations

  1. Istituto Fisiologia Clinica CNR, Dipartimento di Cardiologia A. De Gasperis, Ospedale Niguarda, Ca’ Granda, Piazza Ospedale Maggiore 3, 20612, Milan, Italy

    G. Baroldi M.D.

  2. Dipartimento di Cardiologia, Ospedale Maggiore, Piazza Ospedale 1, 34129, Trieste, Italy

    F. Camerini M.D.

  3. 2 Pine Grove, Lake Road, SW19 7HE, Wimbledon, London, UK

    J. F. Goodwin M.D.

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Bonow, R.O. (1990). Left Ventricular Diastolic Function and Myocardial Ischemia in Hypertrophic Cardiomyopathy: Assessment by Radionuclide Methods. In: Baroldi, G., Camerini, F., Goodwin, J.F. (eds) Advances in Cardiomyopathies. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-83760-9_7

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  • DOI: https://doi.org/10.1007/978-3-642-83760-9_7

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