Myocardial Perfusion in Nonischemic Dilated Cardiomyopathy With and Without Atrial Fibrillation

¹ Department of Nuclear Medicine, University of Münster, Münster, Germany; Department of Cardiology and Angiology, University of Münster, Münster, Germany; Interdisciplinary Centre of Clinical Research (IZKF), University of Münster, Münster, Germany
² Department of Cardiology and Angiology, University of Münster, Münster, Germany; Interdisciplinary Centre of Clinical Research (IZKF), University of Münster, Münster, Germany
³ Department of Nuclear Medicine, University of Münster, Münster, Germany
⁴ Department of Cardiology and Angiology, University of Münster, Münster, Germany
⁵ Department of Nuclear Medicine, University of Münster, Münster, Germany; Interdisciplinary Centre of Clinical Research (IZKF), University of Münster, Münster, Germany

^* To whom correspondence should be addressed. E-mail: schafmi{at}uni-muenster.de.

	Abstract

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

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