PMID- 29051976 OWN - NLM STAT- MEDLINE DCOM- 20180727 LR - 20181113 IS - 1615-2573 (Electronic) IS - 0910-8327 (Linking) VI - 33 IP - 4 DP - 2018 Apr TI - Late gadolinium enhancement on cardiac magnetic resonance imaging is associated with coronary endothelial dysfunction in patients with dilated cardiomyopathy. PG - 393-402 LID - 10.1007/s00380-017-1069-1 [doi] AB - Myocardial fibrosis and coronary endothelial dysfunction are important determinants of outcome in patients with heart failure. However, the relationship of these factors in patients with dilated cardiomyopathy (DCM) is not fully understood. This study aimed to investigate the relationship between endothelium-dependent coronary vasomotor abnormality and late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in patients with DCM. We examined 38 consecutive patients with DCM. All patients underwent CMR and the acetylcholine (ACh) provocation test using cardiac catheterization. During the ACh provocation test, we sampled blood simultaneously from the coronary sinus and aortic root to compare lactate concentrations, and quantified coronary blood flow volume using an intracoronary Doppler-tipped guidewire. LGE was detected in 17 (44.7%) patients. The lactate extraction ratio (LER) in the ACh provocation test was significantly decreased in the LGE-positive group (before vs after ACh, 18.6 +/- 13.6 vs - 13.3 +/- 24.8%; p < 0.001) and in the LGE-negative group (before vs after ACh, 14.2 +/- 19.5 vs 3.3 +/- 16.2%; p = 0.02). The rate of patients with an LER < 0% (indicating myocardial lactate production due to myocardial ischemia) was significantly higher in the LGE-positive group than in the LGE-negative group [12 (70.6%) vs 7 (33.3%); p = 0.02]. Multivariable logistic regression analysis showed that a post-ACh LER < 0% was a significant predictor of LGE positivity (odds ratio 7.75; 95% confidence interval 1.37-43.68; p = 0.02). In conclusion, ACh-provoked coronary vasomotor abnormality is associated with myocardial fibrosis in patients with DCM. These results suggest that coronary endothelial dysfunction is involved in myocardial fibrosis and worsening heart failure concomitant with DCM. FAU - Nakayama, Mina AU - Nakayama M AD - Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. FAU - Yamamuro, Megumi AU - Yamamuro M AD - Department of Cardiovascular Medicine, Kagoshima Tokushukai Hospital, Kagoshima, Japan. FAU - Takashio, Seiji AU - Takashio S AD - Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. s-takash@kumamoto-u.ac.jp. FAU - Uemura, Tomoaki AU - Uemura T AD - Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. FAU - Nakayama, Naoki AU - Nakayama N AD - Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. FAU - Hirakawa, Kyoko AU - Hirakawa K AD - Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. FAU - Oda, Seitaro AU - Oda S AD - Departments of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Utsunomiya, Daisuke AU - Utsunomiya D AD - Departments of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Kaikita, Koichi AU - Kaikita K AD - Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. FAU - Hokimoto, Seiji AU - Hokimoto S AD - Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. FAU - Yamashita, Yasuyuki AU - Yamashita Y AD - Departments of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. FAU - Morita, Yukiko AU - Morita Y AD - Department of Cardiology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan. FAU - Kimura, Kazuo AU - Kimura K AD - Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. FAU - Tamura, Kouichi AU - Tamura K AD - Department of Medical Science and Cardiorenal Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan. FAU - Tsujita, Kenichi AU - Tsujita K AD - Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. LA - eng PT - Journal Article DEP - 20171019 PL - Japan TA - Heart Vessels JT - Heart and vessels JID - 8511258 RN - 0 (Contrast Media) RN - K2I13DR72L (Gadolinium DTPA) SB - IM MH - Cardiomyopathy, Dilated/*diagnosis/metabolism/physiopathology MH - Contrast Media/pharmacology MH - Coronary Vessels/*diagnostic imaging/physiopathology MH - Echocardiography, Doppler MH - Endothelium, Vascular/*physiopathology MH - Female MH - Gadolinium DTPA/*pharmacology MH - Humans MH - Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Myocardium/*pathology MH - Predictive Value of Tests MH - Retrospective Studies MH - Time Factors MH - Vasodilation/*physiology MH - Ventricular Function, Left/*physiology OTO - NOTNLM OT - Endothelium-dependent coronary microvascular dysfunction OT - Fibrosis OT - Heart failure OT - Magnetic resonance imaging EDAT- 2017/10/21 06:00 MHDA- 2018/07/28 06:00 CRDT- 2017/10/21 06:00 PHST- 2017/07/23 00:00 [received] PHST- 2017/10/13 00:00 [accepted] PHST- 2017/10/21 06:00 [pubmed] PHST- 2018/07/28 06:00 [medline] PHST- 2017/10/21 06:00 [entrez] AID - 10.1007/s00380-017-1069-1 [pii] AID - 10.1007/s00380-017-1069-1 [doi] PST - ppublish SO - Heart Vessels. 2018 Apr;33(4):393-402. doi: 10.1007/s00380-017-1069-1. Epub 2017 Oct 19.