From the Department of Cardiology of the Thoraxcenter and Department of
Pathology (M.K.), Erasmus University Rotterdam, Netherlands.
Correspondence to Rob Krams, MD, PhD, Laboratory for Hemodynamics, Room Ee2322, Erasmus University Rotterdam, PO Box 1738, Dr Molewaterplein 30, 3000 DR Rotterdam, The Netherlands.
Background—Ischemia occurs
frequently in hypertrophic cardiomyopathy (HCM)
without evidence of epicardial stenosis. This study evaluates
the hypothesis that the occurrence of ischemia in HCM is
related to remodeling of the coronary microcirculation.
Methods and Results—End-diastolic septal wall
thickness was significantly increased in patients with HCM
(25.8±2.9 mm) in comparison with cardiac transplant recipients
(control subjects: 11.4±3.0 mm; P<0.05). Although
the diameter of the left anterior descending coronary artery
was similar in both groups (3.0±0.8 versus 3.0±0.5 mm,
P=NS), the coronary resistance reserve
(CRR=CRRbasal/CRRhyperemic), corrected
for extravascular compression (end-diastolic left
ventricular pressure), was reduced to 1.5±0.6 in HCM
(P<.05; control, 2.6±0.8). Arteriolar lumen (AL)
divided by wall area was lower in HCM (21±5% versus 30±4%;
P<.05), and capillary density tended to decrease (from
1824±424 to 1445±513 per mm2, P=.11)
in HCM. CRR was linearly related to normalized AL according to the
formula CRR=0.1 AL-0.45 (r=.57; P<.05).
Further analysis revealed that CRR, AL, and capillary density
were all linearly related to the degree of hypertrophy.
Conclusions—Decrements in CRR were related to changes of the
coronary microcirculation. Both the decrease in CRR and these
changes in the coronary microcirculation were related to the
degree of hypertrophy. All these factors might contribute
to the well-known occurrence of ischemia in this patient group.
© 1998 American Heart Association, Inc.
Brief Rapid Communications
Decreased Coronary Flow Reserve in Hypertrophic Cardiomyopathy Is Related to Remodeling of the Coronary Microcirculation
Key Words: cardiomyopathy • arteries • capillaries • ischemia
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