Sciagrà Roberto, Sotgia Barbara, Olivotto Iacopo, Cecchi Franco, Nistri Stefano, Camici Paolo G, Pupi Alberto
Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, 50134, Florence, Italy.
J Nucl Cardiol. 2009 Jan-Feb;16(1):92-6. doi: 10.1007/s12350-008-9005-5. Epub 2009 Jan 20.
Atrial fibrillation (AF) and coronary microvascular dysfunction (CMD) are common in hypertrophic cardiomyopathy (HCM), but whether they are associated is unclear. We assessed the relationship between AF and CMD in HCM.
Global hyperemic myocardial blood flow (hMBF) was measured in 95 HCM patients (16 with, 79 without paroxysmal or chronic AF) by N-13 ammonia positron emission tomography (PET) after dipyridamole infusion. AF patients were older (50.5 +/- 13.4 vs. 38.7 +/- 14.9 years, P < .0005), had larger left atrial diameter (49.8 +/- 7.4 vs 38.6 +/- 5.7 mm, P < .00001), and left ventricular end-systolic diameter (30.4 +/- 6.7 vs 25.5 +/- 5.3 mm, P < .005) compared with those in stable sinus rhythm. In patients with AF, hMBF was significantly lower (1.23 +/- 0.44 vs 1.87 +/- 0.90 mL/min/g, P < 0.0001). In multivariate logistic regression analysis, hMBF, left atrial diameter, and age were independently associated with AF (P < .05 for all).
HCM patients with paroxysmal or chronic AF have lower hMBF than those in stable sinus rhythm. The association between CMD and AF is independent of other known predictors of AF, suggesting a causal link between these two features.
心房颤动（AF）和冠状动脉微血管功能障碍（CMD）在肥厚型心肌病（HCM）中很常见，但它们是否相关尚不清楚。我们评估了HCM中AF与CMD之间的关系。
通过静脉注射双嘧达莫后，采用N-13氨正电子发射断层扫描（PET）对95例HCM患者（16例有阵发性或慢性AF，79例无）的整体充血性心肌血流量（hMBF）进行测量。与窦性心律稳定的患者相比，AF患者年龄更大（50.5±13.4岁对38.7±14.9岁，P<.0005），左心房直径更大（49.8±7.4对38.6±5.7mm，P<.00001），左心室收缩末期直径更大（30.4±6.7对25.5±5.3mm，P<.005）。AF患者的hMBF显著降低（1.23±0.44对1.87±0.90mL/min/g，P<0.0001）。在多因素逻辑回归分析中，hMBF、左心房直径和年龄与AF独立相关（均P<.05）。
阵发性或慢性AF的HCM患者的hMBF低于窦性心律稳定的患者。CMD与AF之间的关联独立于其他已知的AF预测因素，提示这两个特征之间存在因果关系。
