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Thorac Cardiovasc Surg 2002; 50(4): 216-222
DOI: 10.1055/s-2002-33092
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Myocardial Collagen Type I and Impaired Left
Ventricular Function under Exercise in Hypertrophic Cardiomyopathy

M.  Mundhenke1 , B.  Schwartzkopff1 , P.  Stark1 , H.  D.  Schulte2 , B.  E.  Strauer1
  • 1Department of Cardiology, Pulmology and Angiology; Medical School of the Heinrich Heine University,
    Düsseldorf, Germany
  • 2Department of Cardiothoracic Surgery, Medical School of the Heinrich Heine University, Düsseldorf, Germany
This paper is dedicated to the 65th anniversary of Prof. Hagen D. Schulte
Further Information

Publication History

Publication Date:
07 August 2002 (online)

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Abstract

Background: Transaortic subvalvular myectomy (TSM) reduces left ventricular outflow tract gradient and improves symptoms and working capacity in patients with hypertrophic obstructive cardiomyopathy (HOCM). Nevertheless, TSM does not completely restore normal ventricular function, and some patients complain of symptoms despite optimal surgical results. Abnormal myocardial collagen structure in hypertrophic cardiomyopathy might be an indicator of impaired cardiac function. Methods: Nine patients with HOCM were investigated. Myocytic diameter, collagen volume fraction and light absorbance of immunohistochemically stained collagen subtype I and its product (Coll Iprod) were measured quantitatively in myectomy specimens. Patients underwent symptom-limited bicycle exercise testing with equilibrium radionuclide angiocardiography to determine ejection fraction (EF). Right heart catheterization was performed simultaneously in order to measure pulmonary capillary wedge pressure (PCWP) as a parameter of global ventricular diastolic filling and cardiac index (CI) as a parameter of functional capacity. Results: Postoperatively, CI increased from 3.1 ± 0.4 to 5.7 ± 1.3 l/min/m2 under exercise. EF was normal at rest (64 ± 9 %) but did not increase significantly under exercise (66 ± 14 %). Coll Iprod (13.62 ± 7.35 Vv%prod) correlated inversely with EF under exercise (r = - 0.64; p = 0.05). PCWP increased under exercise from 8 ± 2 mmHg at rest to 22 ± 9 mmHg (p = 0.01). Coll Iprod correlated with PCWP under exercise (r = 0.90; p = 0.001). Conclusions: Increased collagen subtype I is a predictor of diastolic as well as systolic dysfunction under exercise in patients with HCM after successful TSM.

Key words

Hypertrophic cardiomyopathy - Collagen - Ventricular function

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1 This paper is dedicated to the 65th anniversary of Prof. Hagen D. Schulte

MD Bodo Schwartzkopff

Division of Cardiology, Medical School of the Heinrich Heine University, Düsseldorf

Moorenstrasse 5

40225 Düsseldorf

Germany

Phone: +49 211 811 88 00

Fax: +49 211 811 95 20

Email: schwartk@uni-duesseldorf.de

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