Skip to main content
SpringerLink
Log in

Coronary artery–left ventricular shunt: an important cause of chest pain in patients with hypertrophic cardiomyopathy

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

The influence of shunts between the coronary artery (CA) and the left ventricle (LV), on chest pain (CP) in patients with hypertrophic cardiomyopathy (HCM) is unknown. We examined the incidence of CA–LV shunts and their influence on CP in HCM patients. Twenty normal control subjects (NCS), 3 with CP due to CA–LV shunts (CP patients), and 60 with HCM participated. Interventricular septal wall thickness (IVST), LV posterior wall thickness (LVPWT), cardiac and stroke indexes (CI and SI), LV end-diastolic pressure (LVEDP), and proximal diameters of the CA were measured. Twenty-five HCM patients had a CA–LV shunt (41.7%). Both IVST and LVPWT were greater in the HCM patients than in NCS and CP patients. These values showed no significant differences between the HCM with shunt and HCM without shunt groups. CI and SI were lower in the HCM patients than in NCS and CP patients. LVEDP was higher in the HCM and CP patients than in NCS. CA diameters were larger in the HCM and CP patients than in NCS. CP was found in 32 HCM patients (53%). The incidence of CP was greater in the HCM with shunt group than in HCM without shunt group (80 vs. 34%, p < 0.0005). There was no significant difference in CA diameters between the HCM patients with CP and those without CP. CA–LV shunts are often found in HCM patients and are closely related to CP. Thus, CA–LV shunts are an important factor behind CP in HCM patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cannon RO, Rosing DR, Maron BJ, Leon MB, Bonow RO, Watoson RM, Epstein SE (1985) Myocardial ischemia in patients with hypertrophic cardiomyopathy: contribution of inadequate vasodilator reserve and elevated left ventricular filling pressures. Circulation 71:234–243

    Article  Google Scholar 

  2. Pasternac A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa MG (1982) Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries. Circulation 65:778–789

    Article  CAS  Google Scholar 

  3. Maron BJ, Epstein SE, Roberts WC (1979) Hypertrophic cardiomyopathy and transmural myocardial infarction without significant atherosclerosis of the extramural coronary arteries. Am J Cardiol 43:1086–1102

    Article  CAS  Google Scholar 

  4. Hamada M, Shigematsu Y, Ohtani T, Ikeda S (2016) Elevated cardiac enzymes in hypertrophic cardiomyopathy patients with heart failure—a 20-year prospective follow-up study. Circ J 80:218–226

    Article  CAS  Google Scholar 

  5. Wearn JT, Mettier SR, Klumpp TG, Zschiesche LJ (1933) The nature of the vascular communications between the coronary arteries and the chambers of the heart. Am Heart J 9:143–164

    Article  Google Scholar 

  6. Prinzmetal M, Simkin B, Bergman HC, Kruger HE (1947) Studies on the coronary circulation. II. The collateral circulation of the normal human heart by coronary perfusion with radioactive erythrocytes and glass spheres. Am Heart J 33:420–442

    Article  CAS  Google Scholar 

  7. Duckworth F, Mukharji J, Vetrovec GW (1987) Diffuse coronary artery to left ventricular communications: an unusual cause of demonstrable ischemia. Chest Cardiovasc Diagn 13:133–137

    Article  CAS  Google Scholar 

  8. Marshall J, Eldredge WJ, Kurnik PB (1990) Coronary artery-to-left ventricle communication with abnormal regional coronary flow demonstrated by ultrafast computed tomography. Am Heart J 119:677–679

    Article  CAS  Google Scholar 

  9. Nagumo S, Ebato M, Kurata M, Wakabayashi K, Shimojima H, Sato T, Hori Y, Suzuki H (2015) A case with apical hypertrophic cardiomyopathy, multiple coronary artery–left ventricular fistulae, and a morphological structure mimicking left ventricular noncompaction. Statue of Cerberus or double-headed eagle? Circulation 131:2161–2163

    Article  Google Scholar 

  10. Matsunaga N (1987) Radiological evaluation of coronary artery–cardiac chamber shunt. Nihon Igaku Hoshasen Gakkai Zasshi 47:1170–1180 (in Japanese with English abstract)

    CAS  PubMed  Google Scholar 

  11. Richardson P, McKenna W, Bristow M, Maisch B, O’Connell J, Olsen E, Thiene G, Goodwin J, Gyarfas I, Martin I, Nordet P (1996) Report of the 1995 World Health Organization/International Society and Federation of Cardiology task force on the definition and classification of cardiomyopathies. Circulation 93:841–842

    Article  CAS  Google Scholar 

  12. AHA Committee Report: a reporting system on patients evaluated for coronary artery disease (1975). Circulation 51(appendix):7–40

  13. Maron BJ, Roberts WC (1979) Quantitative analysis of cardiac muscle cell disorganization in the ventricular septum of patients with hypertrophic cardiomyopathy. Circulation 59:689–706

    Article  CAS  Google Scholar 

  14. Lewis BS, Gotsman MS (1973) Relation between coronary artery size and left ventricular wall mass. Br Heart J 35:1150–1153

    Article  CAS  Google Scholar 

  15. Paulsen S, Vetner M, Hagerup LM (1975) Relationship between heart weight and the cross-sectional area of the coronary ostia. Acta Pathol Microbiol Scand A 83:429–432

    CAS  PubMed  Google Scholar 

  16. Kimball BP, LiPreti V, Bui S, Wigle ED (1990) Comparison of proximal left anterior descending and circumflex coronary artery dimensions in aortic valve stenosis and hypertrophic cardiomyopathy. Am J Cardiol 65:767–771

    Article  CAS  Google Scholar 

  17. Hanrath P, Mathey D, Montz R, Thel V, Vorbringer H, Kupper W, Schneider C, Bleifeld W (1981) Myocardial thallium-201 imaging in hypertrophic obstructive cardiomyopathy. Eur Heart J 2:177–185

    Article  CAS  Google Scholar 

  18. O’Gara PT, Bonow RO, Maron BJ, Damske BA, VanLingen A, Bacharach SL, Larson SM, Epstein SE (1987) Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography. Circulation 76:1214–1223

    Article  Google Scholar 

  19. Pitcher D, Wainwright R, Maisey M, Curry P, Lowton E (1980) Assessment of chest pain in hypertrophic cardiomyopathy using exercise thallium-201 myocardial imaging scintigraphy. Br Heart J 44:650–656

    Article  CAS  Google Scholar 

  20. Marcus ML, Doty DB, Hiratzka LF, Wright CB, Eastham CL (1982) Decreased coronary reserve: a mechanism for angina pectoris with aortic stenosis and normal coronary arteries. N Engl J Med 307:1362–1366

    Article  CAS  Google Scholar 

  21. Opherk D, Mall G, Zebe H, Schwarz F, Weihe E, Manthey J, Kubler W (1984) Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries. Circulation 69:1–7

    Article  CAS  Google Scholar 

  22. Hamada M, Ikeda S, Ohshima K, Nakamura M, Kubota N, Ogimoto A, Shigematsu Y (2016) Impact of chronic use of cibenzoline on left ventricular pressure gradient and left ventricular remodeling in patients with hypertrophic obstructive cardiomyopathy. J Cardiol 67:279–286

    Article  Google Scholar 

  23. Matsuda J, Kitamura M, Takayama M, Imori Y, Shibuya J, Kubota Y, Sangen H, Nakamura S, Takano H, Asai K, Shimizu W (2017) Chronic phase improvements in electrocardiographic and echocardiographic manifestations of left ventricular hypertrophy after alcohol septal ablation for drug-refractory hypertrophic obstructive cardiomyopathy. Heart Vessels. https://doi.org/10.1007/s00380-017-1053-9

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime, 798-8510, Japan

    Mareomi Hamada, Akiyoshi Ogimoto, Kiyotaka Ohshima & Shigehiro Miyazaki

  2. Division of Physiological Laboratory, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime, 798-8510, Japan

    Norio Kubota

  3. Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan

    Shuntarto Ikeda

  4. Fundamental and Clinical Nursing, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan

    Yuji Shigematsu

Authors
  1. Mareomi Hamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akiyoshi Ogimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiyotaka Ohshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shigehiro Miyazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Norio Kubota
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shuntarto Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuji Shigematsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mareomi Hamada.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hamada, M., Ogimoto, A., Ohshima, K. et al. Coronary artery–left ventricular shunt: an important cause of chest pain in patients with hypertrophic cardiomyopathy. Heart Vessels 33, 1267–1274 (2018). https://doi.org/10.1007/s00380-018-1178-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-018-1178-5

Keywords

Search

Navigation