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Cardiovascular Research 2002 55(1):97-103; doi:10.1016/S0008-6363(02)00331-0
© 2002 by European Society of Cardiology
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Copyright © 2002, European Society of Cardiology

Abnormalities in myocardial contractility, metabolism and perfusion reserve in non-stenotic coronary segments in heart failure patients

Ad F.M van den Heuvela,*, Jeroen J Baxb, Paul K Blanksmaa, Willem Vaalburgc, Harry J.G.M Crijnsd and Dirk J van Veldhuisena,1

aDepartment of Cardiology/Thoraxcenter, University Hospital Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
bDepartment of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
cPET Center, University Hospital Groningen, Groningen, The Netherlands
dDepartment of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands

a.f.m.van.den.heuvel{at}thorax.azg.nl

* Corresponding author. Tel.: +31-50-361-2355; fax: +31-50-361-4391

Objective: Myocardial blood flow (MBF) reserve is impaired in congestive heart failure (CHF), while fluorine-18-deoxyglucose (18FDG) uptake is relatively preserved. To determine whether this mismatch could be interpreted as ischemia, we performed dobutamine stress echocardiography (DSE). Methods: 12 males with coronary artery disease (CAD) and CHF were compared with 12 controls with similar CAD but normal left ventricular (LV) function. MBF in non-infarct-related artery areas was assessed using [13N]ammonia positron emission tomography (PET), at rest and after dipyridamole infusion and 18FDG uptake was determined. DSE was performed with doses up to 40 µg/kg per min. Results: In areas with non-stenotic arteries MBF reserve was more impaired in CHF patients (1.6±0.6 vs. 2.2±0.5; CHF versus normal LV, respectively, P<0.05). MBF reserve was related to LV ejection fraction (r = 0.6, P<0.05) and wall stress (r = –0.72, P<0.05). PET showed mismatch in 4±1% of the myocardium in normal LV, compared to 26±26% in CHF (P<0.05), coinciding with more ischemic wall motion abnormalities on DSE (21 vs. 4%; CHF versus normal LV, respectively, P<0.05). Conclusions: In CHF, mismatch was found in areas supplied by non-stenotic coronary arteries. Corresponding areas showed ischemic wall motions on DSE. These findings suggest that the condition of CHF may play a role in perpetuating myocardial failure by inducing myocardial ischemia. Follow-up studies to investigate the ischemia–CHF relationship in time would be needed.

KEYWORDS Heart failure; Ischemia; Regional blood flow; Cardiomyopathy; Energy metabolism

1 Dr. D.J. van Veldhuisen is an Established Investigator of the Netherlands Heart Foundation, Grant D97-017.


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