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First published online February 17, 2009, 10.2967/jnumed.108.055665
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Journal of Nuclear Medicine Vol. 50 No. 3 390-396
© 2009 by Society of Nuclear Medicine

doi: 10.2967/jnumed.108.055665

Clinical Investigation

Myocardial Perfusion in Nonischemic Dilated Cardiomyopathy With and Without Atrial Fibrillation

Felix T. Range*,1–3, Matthias Paul*,2,3, Klaus P. Schäfers1, Tayfun Acil2, Peter Kies1,3, Sven Hermann1, Otmar Schober1, Günter Breithardt2, Thomas Wichter2,3 and Michael A. Schäfers1,3

1 Department of Nuclear Medicine, University of Münster, Münster, Germany; 2 Department of Cardiology and Angiology, University of Münster, Münster, Germany; and 3 Interdisciplinary Centre of Clinical Research (IZKF), University of Münster, Münster, Germany

Correspondence: For correspondence or reprints contact: Michael A. Schäfers, Department of Nuclear Medicine, Albert-Schweitzer-Strasse 33, D-48149, Münster, Germany. E-mail: schafmi{at}uni-muenster.de

Recent studies have shown that idiopathic atrial fibrillation (AF) is associated with diminished myocardial perfusion and perfusion reserve, which are also impaired in various forms of cardiomyopathies. In many cases, AF develops during progression of dilated cardiomyopathy (DCM) and may aggravate heart failure. This study compared myocardial perfusion between patients with nonischemic DCM with and without AF. Methods: Twelve men (age ± SD, 55 ± 12 y) who had DCM and persistent AF were compared with a group of 18 men (mean age, 43 ± 15 y, P = not statistically significant) who had DCM and sinus rhythm and with 22 healthy controls (mean age, 47 ± 13 y, P = not statistically significant). Myocardial blood flow (MBF) was noninvasively quantified at rest and during adenosine infusion using PET and radioactive-labeled water (H215O PET). Results: Compared with controls, DCM patients without AF showed impaired hyperemic perfusion (2.52 ± 1.29 vs. 3.57 ± 0.88 mL/min/mL, P = 0.014) and perfusion reserve (2.10 ± 1.01 vs. 3.37 ± 0.97, P = 0.003). However, compared with DCM patients without AF, DCM patients with AF showed an additional impairment in resting perfusion (0.82 ± 0.31 mL/min/mL, P = 0.010) and hyperemic perfusion (1.32 ± 0.93 mL/min/mL, P = 0.022), and compared with controls, DCM patients with AF showed a further diminishment of perfusion reserve (1.68 ± 0.94 vs. 3.37 ± 0.97, P < 0.001) accompanied by the highest coronary vascular resistance of all groups. Conclusion: Compared with patients with sinus rhythm, patients with AF have significantly reduced myocardial perfusion reserve and increased coronary resistance in nonischemic DCM. Further studies on the underlying pathomechanisms are warranted.

Key Words: atrial fibrillation • dilated cardiomyopathy • myocardial blood flow • positron emission tomography

* Contributed equally to this work.

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.


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