Microvascular Dysfunction in Hypertrophic Cardiomyopathy

Abstract

In hypertrophic cardiomyopathy (HCM), the presence of vessel abnormalities with microvascular dysfunction is a well-known feature. The aim of this review is to present the evidences that support this notion and to describe the physiopathologic and clinical consequences of microvascular dysfunction. After having demonstrated the presence and significance of microvascular dysfunction in HCM, the myocardial blood flow (MBF) measurement by positron emission tomography (PET) is ready to develop into a clinical tool for disease evaluation, in particular for patient prognostication. Alternative methods are becoming available, but they are not yet equally reliable. By means of MBF measurement using quantitative PET, the importance of microvascular dysfunction in HCM has been clearly demonstrated, explaining the chest pain and the ischemic abnormalities frequently registered in this disease. The physiopathologic implications of microvascular dysfunction have been established, and an increasing number of reports indicate that the assessment of microvascular dysfunction is as well important for patient characterization and prognostication. Most recently, perfusion measurements using magnetic resonance imaging have been used, but their role is still under debate.