2016


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2016/№4

Features of myocardial perfusion of hypertrophic left ventricular with primary hypertrophy of apical segments and the lateral wall at an arterial hypertension

Malov A. A., Feiskhanova L. I.
State Budgetary Educational Institution “Kazan State Medical University” of the RF Ministry of Health Care, Butlerova 49, Kazan 420012

Keywords: left ventricle hypertrophy, single-photon emission computed tomography, coronary reserve, MRI

DOI: 10.18087/rhj.2016.4.2184

Background. AH clinical severity and prognosis are determined not only by the magnitude of BP increase but also to a significant degree by damage to target organs, including the presence of LV myocardial hypertrophy (LVMH). According to many reports, microcirculatory disorders play an important role in LVMH development and progression. Aim. To study features of coronary hemodynamics in patients with LVMH. Materials and methods. A group of 45 patients aged 58.4±10.3 with grade II-III AH was formed. LV structure and function parameters were determined using ECG and magnetic resonance imaging (MRI). Coronary hemodynamics was studied using ECG-synchronized single-photon emission computed tomography (SPECT) with a radiopharmaceutical (RP) 99mТс-Technetril (99mТс-MIBI) at rest and in combination with bicycle ergometry (BEM). Cardiac MRI without contrast was performed for additional LV visualization. Results. MRI data showed that 67 % of patients had concentric hypertrophy, 22 % of patients had concentric remodeling, and 11 % of patients had eccentric LVMH. Patients were divided into groups with symmetrical concentric LVMH and two asymmetric hypertrophy types (with primary hypertrophy of apical segments and the LV lateral wall). According to SPECT data disorders of coronary hemodynamics as a factor of LVMH progression were observed both in patients with symmetrical hypertrophy and hypertrophy with primary thickening of LV apical and lateral segments. In patients with symmetrical concentric LVMH, the RP was relatively evenly distributed over all LV segments. In patients with asymmetric LVMH, the RP was unevenly distributed with increased resting perfusion of thickened LV segments. Furthermore, in some of these patients during the exercise, these segments showed a relative decrease in RP uptake, and parameters of their regional contractility were reduced due to decreased coronary reserve (CR) of hypertrophic segments. Conclusion. SPECT allowed to identify among LVMH patients those with symmetric, concentric LVMH and with two types of asymmetric, concentric hypertrophy as well as those with reduced CR. The use of MRI provided accurate visualization and measurement of hypertrophic segment thickness.
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Malov A. A., Feiskhanova L. I. Features of myocardial perfusion of hypertrophic left ventricular with primary hypertrophy of apical segments and the lateral wall at an arterial hypertension. Russian Heart Journal. 2016;15 (4):284–292

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