Imperial College London
Portrait Picture

Dr Sukhjinder Singh Nijjer

Faculty of Medicine, National Heart & Lung Institute

Honorary Senior Clinical Lecturer
 
 
 
//

Contact

 

s.nijjer Website

 
 
//

Location

 

Block B Hammersmith HospitalHammersmith Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Raphael:2016:10.1016/j.jacc.2016.07.751,
author = {Raphael, CE and Cooper, R and Parker, KH and Collinson, J and Vassiliou, V and Pennell, DJ and de, Silva R and Hsu, LY and Greve, AM and Nijjer, S and Broyd, C and Ali, A and Keegan, J and Francis, DP and Davies, JE and Hughes, AD and Arai, A and Frenneaux, M and Stables, RH and Di, Mario C and Prasad, SK},
doi = {10.1016/j.jacc.2016.07.751},
journal = {Journal of the American College of Cardiology},
pages = {1651--1660},
title = {Mechanisms of myocardial ischemia in hypertrophic cardiomyopathy: insights from wave intensity analysis and magnetic resonance},
url = {http://dx.doi.org/10.1016/j.jacc.2016.07.751},
volume = {68},
year = {2016}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: Angina is common in hypertrophic cardiomyopathy (HCM) and is associated with abnormal myocardial perfusion. Wave intensity analysis improves the understanding of the mechanics of myocardial ischemia. OBJECTIVES: Wave intensity analysis was used to describe the mechanisms underlying perfusion abnormalities in patients with HCM. METHODS: Simultaneous pressure and flow were measured in the proximal left anterior descending artery in 33 patients with HCM and 20 control patients at rest and during hyperemia, allowing calculation of wave intensity. Patients also underwent quantitative first-pass perfusion cardiac magnetic resonance to measure myocardial perfusion reserve. RESULTS: Patients with HCM had a lower coronary flow reserve than control subjects (1.9 ± 0.8 vs. 2.7 ± 0.9; p = 0.01). Coronary hemodynamics in HCM were characterized by a very large backward compression wave during systole (38 ± 11% vs. 21 ± 6%; p < 0.001) and a proportionately smaller backward expansion wave (27% ± 8% vs. 33 ± 6%; p = 0.006) compared with control subjects. Patients with severe left ventricular outflow tract obstruction had a bisferiens pressure waveform resulting in an additional proximally originating deceleration wave during systole. The proportion of waves acting to accelerate coronary flow increased with hyperemia, and the magnitude of change was proportional to the myocardial perfusion reserve (rho = 0.53; p < 0.01). CONCLUSIONS: Coronary flow in patients with HCM is deranged. Distally, compressive deformation of intramyocardial blood vessels during systole results in an abnormally large backward compression wave, whereas proximally, severe left ventricular outflow tract obstruction is associated with an additional deceleration wave. Perfusion abnormalities in HCM are not simply a consequence of supply/demand mismatch or remodeling of the intramyocardial blood vessels; th
AU  - Raphael,CE
AU  - Cooper,R
AU  - Parker,KH
AU  - Collinson,J
AU  - Vassiliou,V
AU  - Pennell,DJ
AU  - de,Silva R
AU  - Hsu,LY
AU  - Greve,AM
AU  - Nijjer,S
AU  - Broyd,C
AU  - Ali,A
AU  - Keegan,J
AU  - Francis,DP
AU  - Davies,JE
AU  - Hughes,AD
AU  - Arai,A
AU  - Frenneaux,M
AU  - Stables,RH
AU  - Di,Mario C
AU  - Prasad,SK
DO  - 10.1016/j.jacc.2016.07.751
EP  - 1660
PY  - 2016///
SN  - 1558-3597
SP  - 1651
TI  - Mechanisms of myocardial ischemia in hypertrophic cardiomyopathy: insights from wave intensity analysis and magnetic resonance
T2  - Journal of the American College of Cardiology
UR  - http://dx.doi.org/10.1016/j.jacc.2016.07.751
UR  - https://www.sciencedirect.com/science/article/pii/S0735109716348860?via%3Dihub
UR  - http://hdl.handle.net/10044/1/41578
VL  - 68
ER  -
Download