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Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy

BACKGROUND: Perfusion defects during stress can occur in hypertrophic cardiomyopathy (HCM) from either structural or functional abnormalities of the coronary microcirculation. In this study, vasodilator stress myocardial contrast echocardiography (MCE) was used to quantify and spatially characterize...

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Autores principales: Roldan, Paola, Ravi, Sriram, Hodovan, James, Belcik, J. Todd, Heitner, Stephen B., Masri, Ahmad, Lindner, Jonathan R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484161/
https://www.ncbi.nlm.nih.gov/pubmed/36117179
http://dx.doi.org/10.1186/s12947-022-00293-2
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author Roldan, Paola
Ravi, Sriram
Hodovan, James
Belcik, J. Todd
Heitner, Stephen B.
Masri, Ahmad
Lindner, Jonathan R.
author_facet Roldan, Paola
Ravi, Sriram
Hodovan, James
Belcik, J. Todd
Heitner, Stephen B.
Masri, Ahmad
Lindner, Jonathan R.
author_sort Roldan, Paola
collection PubMed
description BACKGROUND: Perfusion defects during stress can occur in hypertrophic cardiomyopathy (HCM) from either structural or functional abnormalities of the coronary microcirculation. In this study, vasodilator stress myocardial contrast echocardiography (MCE) was used to quantify and spatially characterize hyperemic myocardial blood flow (MBF) deficits in HCM. METHODS: Regadenoson stress MCE was performed in patients with septal-variant HCM (n = 17) and healthy control subjects (n = 15). The presence and spatial distribution (transmural diffuse, patchy, subendocardial) of perfusion defects was determined by semiquantitative analysis. Kinetic analysis of time-intensity data was used to quantify MBF, microvascular flux rate (β), and microvascular blood volume. In patients undergoing septal myectomy (n = 3), MCE was repeated > 1 years after surgery.  RESULTS: In HCM subjects, perfusion defects during stress occurred in the septum in 80%, and in non-hypertrophied regions in 40%. The majority of septal defects (83%) were patchy or subendocardial, while 67% of non-hypertrophied defects were transmural and diffuse. On quantitative analysis, hyperemic MBF was approximately 50% lower (p < 0.001) in the hypertrophied and non-hypertrophied regions of those with HCM compared to controls, largely based on an inability to augment β, although hypertrophic regions also had blood volume deficits. There was no correlation between hyperemic MBF and either percent fibrosis on magnetic resonance imaging or outflow gradient, yet those with higher degrees of fibrosis (≥ 5%) or severe gradients all had low septal MBF during regadenoson. Substantial improvement in hyperemic MBF was observed in two of the three subjects undergoing myectomy, both of whom had severe pre-surgical outflow gradients at rest. CONCLUSION: Perfusion defects on vasodilator MCE are common in HCM, particularly in those with extensive fibrosis, but have a different spatial pattern for the hypertrophied and non-hypertrophied segments, likely reflecting different contributions of functional and structural abnormalities. Improvement in hyperemic perfusion is possible in those undergoing septal myectomy to relieve obstruction.  TRIAL REGISTRATION: ClinicalTrials.gov NCT02560467. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12947-022-00293-2.
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spelling pubmed-94841612022-09-20 Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy Roldan, Paola Ravi, Sriram Hodovan, James Belcik, J. Todd Heitner, Stephen B. Masri, Ahmad Lindner, Jonathan R. Cardiovasc Ultrasound Research BACKGROUND: Perfusion defects during stress can occur in hypertrophic cardiomyopathy (HCM) from either structural or functional abnormalities of the coronary microcirculation. In this study, vasodilator stress myocardial contrast echocardiography (MCE) was used to quantify and spatially characterize hyperemic myocardial blood flow (MBF) deficits in HCM. METHODS: Regadenoson stress MCE was performed in patients with septal-variant HCM (n = 17) and healthy control subjects (n = 15). The presence and spatial distribution (transmural diffuse, patchy, subendocardial) of perfusion defects was determined by semiquantitative analysis. Kinetic analysis of time-intensity data was used to quantify MBF, microvascular flux rate (β), and microvascular blood volume. In patients undergoing septal myectomy (n = 3), MCE was repeated > 1 years after surgery.  RESULTS: In HCM subjects, perfusion defects during stress occurred in the septum in 80%, and in non-hypertrophied regions in 40%. The majority of septal defects (83%) were patchy or subendocardial, while 67% of non-hypertrophied defects were transmural and diffuse. On quantitative analysis, hyperemic MBF was approximately 50% lower (p < 0.001) in the hypertrophied and non-hypertrophied regions of those with HCM compared to controls, largely based on an inability to augment β, although hypertrophic regions also had blood volume deficits. There was no correlation between hyperemic MBF and either percent fibrosis on magnetic resonance imaging or outflow gradient, yet those with higher degrees of fibrosis (≥ 5%) or severe gradients all had low septal MBF during regadenoson. Substantial improvement in hyperemic MBF was observed in two of the three subjects undergoing myectomy, both of whom had severe pre-surgical outflow gradients at rest. CONCLUSION: Perfusion defects on vasodilator MCE are common in HCM, particularly in those with extensive fibrosis, but have a different spatial pattern for the hypertrophied and non-hypertrophied segments, likely reflecting different contributions of functional and structural abnormalities. Improvement in hyperemic perfusion is possible in those undergoing septal myectomy to relieve obstruction.  TRIAL REGISTRATION: ClinicalTrials.gov NCT02560467. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12947-022-00293-2. BioMed Central 2022-09-19 /pmc/articles/PMC9484161/ /pubmed/36117179 http://dx.doi.org/10.1186/s12947-022-00293-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Roldan, Paola
Ravi, Sriram
Hodovan, James
Belcik, J. Todd
Heitner, Stephen B.
Masri, Ahmad
Lindner, Jonathan R.
Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy
title Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy
title_full Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy
title_fullStr Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy
title_full_unstemmed Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy
title_short Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy
title_sort myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484161/
https://www.ncbi.nlm.nih.gov/pubmed/36117179
http://dx.doi.org/10.1186/s12947-022-00293-2
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