Abnormalities in myocardial contractility, metabolism and perfusion reserve in non-stenotic coronary segments in heart failure patients

Objective: Myocardial blood flow (MBF) reserve is impaired in congestive heart failure (CHF), while fluorine-18-deoxyglucose ((18)FDG) uptake is relatively preserved. To determine whether this mismatch could be interpreted as ischemia, we performed dobutamine stress echocardiography (DSE). Methods: 12 males with coronary artery disease (CAD) and CHF were compared with 12 controls with similar CAD but normal left ventricular (LV) function. MBF in non-infarct-related artery areas was assessed using [N-13]ammonia positron emission tomography (PET), at rest and after dipyridamole infusion and (18)FDG uptake was determined. DSE was performed with doses up to 40 mug/kg per min. Results: In areas with non-stenotic arteries MBF reserve was more impaired in CHF patients (1.6+/-1-0.6 vs. 2.2+/-0.5; CHF versus normal LV, respectively, P