Author + information
- Received April 4, 1996
- Revision received July 11, 1996
- Accepted August 14, 1996
- Published online December 1, 1996.
- Olli-Pekka Pitkänen, MD1,
- Olli T. Raitakari, MD1,
- Harri Niinikoski, MD1,
- Pirjo Nuutila, MD1,
- Hidehiro Iida, PHD*,
- Liisa-Maria Voipio-Pulkki, MD1,
- Risto Härkönen, MD1,
- Uno Wegelius, MD1,
- Tapani Rönnemaa, MD1,
- Jorma Viikari, MD1 and
- Juhani Knuuti, MD1,⁎
- ↵⁎Address for correspondence: Dr. Juhani Knuuti, Department of Nuclear Medicine and Turku PET Center, Turku University Central Hospital, FIN-20520 Turku, Finland.
Objectives We sought to investigate whether functional abnormalities in coronary vasomotion exist in young adults by studying 15 men (age 31 ± 8 years [mean ± SD]) with familial hypercholesterolemia (FH) and a matched group of 20 healthy control subjects.
Background Precursors of morphologic coronary artery disease are known to be present in adolescents and young adults with a high risk factor profile.
Methods Myocardial blood flow was measured at the basal state and during dipyridamole-induced hyperemia using positron emission tomography and oxygen-15 llabeled water.
Results Serum total and low density lipoprotein cholesterol concentrations were higher in the patients than in the control subjects (mean ± SD): 7.7 ± 1.9 versus 5.3 ± 1.5 mmol/liter (298 ± 73 vs. 205 ± 58 mg/dl) and 6.1 ± 1.8 versus 3.5 ± 1.4 mmol/liter (236 ± 70 vs. 135 ± 54 mg/dl), respectively (both p < 0.001). The baseline myocardial blood flow was similar in the patients and control subjects: 0.92 ± 0.24 versus 0.83 ± 0.13 ml/g per min, respectively (p = 0.21). A significant increase in flow was observed in both groups after dipyridamole infusion, but the flow at maximal vasodilation was 29% lower in the patients: 3.19 ± 1.59 versus 4.49 ± 1.27 ml/g per min (p = 0.011). Consequently, coronary flow reserve (the ratio of hyperemia flow to basal flow) was 35% lower in the patients than in the control subjects: 3.5 ± 1.6 versus 5.4 ± 1.5 (p = 0.0008). Total coronary resistance during hyperemia was higher in the patients than in the control subjects: 36 ± 25 versus 21 ± 10 mm Hg/min per g per ml (p = 0.045). Coronary flow reserve was inversely associated with serum total cholesterol concentration: r =−0.43 (p = 0.009).
Conclusions Coronary flow reserve is reduced in young men with FH, and, consequently, coronary resistance during hyperemia is increased. The results demonstrate very early impairment of coronary vasomotion in hypercholesterolemic patients.
* The study was supported by grants from the Novo Nordisk Foundation, Turku University Foundation, Turku; and the Finnish Foundation for Cardiovascular Research, the Emil Aaltonen Foundation and the Sigrid Juselius Foundation, Helsinki, Finland.
- Received April 4, 1996.
- Revision received July 11, 1996.
- Accepted August 14, 1996.
- American College of Cardiology