Chest pain is a frequent complaint in patients with dilated cardiomyopathy (DCMP). Myocardial blood flow, coronary circulation parameters and coronary sinus lactate content were measured in 14 patients with DCMP and 10 healthy subjects. Myocardial blood flow in DCMP was 53.1 +/- 3.3 vs. 66.3 +/- 4.9 ml/min/100 g in the control group (p less than 0.05), coronary driving pressure was 59.1 +/- 4.6 vs. 72.8 +/- 8.8 mmHg (p less than 0.01). Subendocardial flow index (DPTI/TTI) in DCMP was 0.76 +/- 0.12 vs. 1.15 +/- 0.19 (p less than 0.01). The lactate content in coronary sinus blood was greater (1.93 +/- 0.45 mmol/l) than in the control group (1.43 +/- 0.48) (p less than 0.05). These results suggest that in DCMP myocardial blood flow is decreased, and in the majority of patients lactate is produced. Thus, it is possible that pain in DCMP is of anginal origin.
Investigations of the hemodynamics of pulmonary circulation, right and left heart venticle and ventilatory function of the lungs were carried out in a group of 12 patients with primary pulmonary hypertension. The results were discussed in the light of data obtained in a group of 16 patients with chronic cor pulmonale syndrome and 16 healthy subjects. It was found that patients with primary pulmonary hypertension show a markedly raised pressure in the pulmonary artery mean pressure x = 60.3 +/- 24.2 mm Hg, in the right ventricle (systolic pressure x = 90.6 +/- 27.9 mm Hg, end-diastolic pressure x = 11.7 +/- 4.3 mm Hg), very high total pulmonary vascular resistance (x = 1571 +/- dynes. sec. cm-5) and increased work of right ventricle (x = 2.3 +/- 1.5 kgm/min/m2). In patients with chronic cor pulmonale syndrome the load on the right ventricle was much lower. The indices determining left ventricle function as a pump indicated that this function was impaired, with lower cardiac index (x = 2.1 +/- 0.8 1/min/m2), stroke volume (x = 41.7 +/- 17.2 ml) and left ventricular work (x = 2.7 +/- 1.1 kgm/min/m2). These changes might, however, be due also to impaired blood flow into the left ventricle. In contrast to patients with chronic cor pulmonale syndrome, the indices of ventilatory function of the lungs were normal or only slightly decreased. No significant correlations were observed between hemodynamic indices of pulmonary circulation and right ventricle and the parameters of the ventilatory function of the lungs.
Left ventricular systolic time intervals were investigated before and after administration i.v. 10 micrograms of isoproterenol in a group of 12 patients with hypertrophic cardiomyopathy. Control group consisted of 10 healthy subjects. Isoproterenol shortened on hypertrophic cardiomyopathy pre-ejection periods: pre-ejection period index, isovolumetric contraction time, and Q-1. sound interval. Q-2. sound interval index did not shorten after isoproterenol what was observed in healthy subjects. Lef ventricular ejection time index lengthened little in patients and shortened in controls. These changes of left ventricular systolic time intervals suggest that isoproterenol makes difficult blood ejection from the ventricle.
