{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:41:29Z","timestamp":1777390889466,"version":"3.51.4"},"reference-count":27,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[1996,2]]},"abstract":"<jats:p>OBJECTIVES: The presence of angina pectoris and myocardial scarring in patients with hypertrophic cardiomyopathy (HCM) suggests that myocardial ischemia is a factor in the pathophysiology of the disease. The clinical evaluation of ischaemia is problematic in HCM as baseline electrocardiographic abnormalities are frequent and thallium-201 perfusion abnormalities correlate poorly with anginal symptoms. Coronary sinus pH measurement using a catheter mounted pH electrode is a validated sensitive technique for the detection of myocardial ischaemia. METHODS AND RESULTS: 11 patients with HCM and chest pain (eight men; mean (SD) (range) age 36 (11) (19-53) years) and six controls (two men; mean (SD) (range) age 49 (11) (31-62) years) with atypical pain and normal coronary angiograms were studied. Eight patients with HCM had baseline ST segment depression of &gt; or = 1 mm and four had reversible perfusion defects during stress 201TI scintigraphy. A catheter mounted hydrogen ion sensitive electrode was introduced into the coronary sinus and pH monitored continuously during dipyridamole infusion (0.56 mg\/kg over four min). The maximal change in coronary sinus pH during dipyridamole stress was greater in patients with HCM than in controls (0.082 (0.083) (0 to -0.275) v 0.005 (0.006) (0 to -0.012), P = 0.02). In six patients (four men; mean (SD) (range) age 29 (9) (19-40 years) the development of chest pain was associated with a gradual decline in coronary sinus pH (mean 0.123 (0.089)), peaking at 442 (106) s. There were no relations among left ventricular dimensions, maximal wall thickness, and maximum pH change. In patients with HCM there was a correlation between maximum pH change and maximum heart rate during dipyridamole infusion (r = 0.70, P = 0.02). CONCLUSION: This study provides further evidence that chest pain in patients with HCM is caused by myocardial ischaemia. The role of myocardial ischaemia in the pathophysiology of the disease remains to be determined but coronary sinus pH monitoring provides a method for quantifying and prospectively assessing its effects on clinical presentation and prognosis.<\/jats:p>","DOI":"10.1136\/hrt.75.2.179","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:46:00Z","timestamp":1190137560000},"page":"179-183","source":"Crossref","is-referenced-by-count":29,"title":["Changes in coronary sinus pH during dipyridamole stress in patients with hypertrophic cardiomyopathy."],"prefix":"10.1136","volume":"75","author":[{"given":"P. M.","family":"Elliott","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. M.","family":"Rosano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. S.","family":"Gill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. A.","family":"Poole-Wilson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. C.","family":"Kaski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. J.","family":"McKenna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1996,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/0002-9149(81)90535-X","article-title":"Prognosis in hypertrophic cardiomyopathy. Role of age and clinical, electrocardiographic and haemodynamic features","volume":"47","author":"McKenna, W.I.; Deanfield, J.; Faruqui, A.; England, D.; Oakley, C.; Goodwin, J.","year":"1981","unstructured":"McKenna WI, Deanfield J, Faruqui A, England D, Oakley C, Goodwin J. Prognosis in hypertrophic cardiomyopathy. Role of age and clinical, electrocardiographic and haemodynamic features. Am Y Cardiol 1981;47:532-8.","journal-title":"Am Y Cardiol"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/S0735-1097(86)80484-3","article-title":"Cardiac arrest in an adolescent with atrial fibrillation and hypertrophic cardiomyopathy","volume":"7","author":"Stafford, W.I.; Trohman, R.G.; Bilsker, M.; Zaman, L.; Catellanos, A.; Myerburg, R.J.","year":"1986","unstructured":"Stafford WI, Trohman RG, Bilsker M, Zaman L, Catellanos A, Myerburg RJ. Cardiac arrest in an adolescent with atrial fibrillation and hypertrophic cardiomyopathy. YAm Coil Cardiol 1986;7:701-4.","journal-title":"YAm Coil Cardiol"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1161\/01.CIR.83.5.1660","article-title":"Myocardial metabolic, hemodynamic, and electrocardiographic significance of reversible thallium-201 abnormalities in hypertrophic cardiomyopathy","volume":"83","author":"Cannon, R.O.; Dilsizian, V.; O'Gara, P.; Udelson, J.E.; Schenke, W.H.; Quyyumi, A.","year":"1991","unstructured":"Cannon RO, Dilsizian V, O'Gara P, Udelson JE, Schenke WH, Quyyumi A, et al. Myocardial metabolic, hemodynamic, and electrocardiographic significance of reversible thallium-201 abnormalities in hypertrophic cardiomyopathy. Circulation 1991;83:1660-7.","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1161\/01.CIR.65.4.778","article-title":"Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteriograms","volume":"65","author":"Pasternac, A.; Noble, J.; Streulens, Y.; Elie, R.; Henschke, C.; Bourassa, M.G.","year":"1982","unstructured":"Pasternac A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa MG. Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteriograms. Circulation 1982;65:778-89.","journal-title":"Circulation"},{"key":"ref_5","first-page":"650","article-title":"Assessment of chest pain in hypertrophic cardiomyopathy using exercise thallium-201 myocardial scintigraphy","volume":"44","author":"Pitcher, D.; Wainwright, R.; Maisey, M.; Curry, P.; Sowton, E.","year":"1980","unstructured":"Pitcher D, Wainwright R, Maisey M, Curry P, Sowton E. Assessment of chest pain in hypertrophic cardiomyopathy using exercise thallium-201 myocardial scintigraphy. BrHeartJ 1980;44:650-6.","journal-title":"BrHeartJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1161\/01.CIR.76.6.1214","article-title":"Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography","volume":"76","author":"O'Gara, P.T.; Bonow, R.O.; Maron, B.J.; Damske, B.A.; Van Lingen, A.; Bacharach, S.L.","year":"1987","unstructured":"O'Gara PT, Bonow RO, Maron BJ, Damske BA, Van Lingen A, Bacharach SL, et al. Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography. Circulation 1987;76: 1214-23.","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/0002-9149(79)90166-8","article-title":"Idiopathic hypertrophic subaortic stenosis: evaluation of anginal symptoms with thallium-201 myocardial imaging","volume":"44","author":"Rubin, K.A.; Morrison, J.; Padnick, M.B.; Binder, A.J.; Chiaramida, S.; Margouleff, D.","year":"1979","unstructured":"Rubin KA, Morrison J, Padnick MB, Binder AJ, Chiaramida S, Margouleff D, et al. Idiopathic hypertrophic subaortic stenosis: evaluation of anginal symptoms with thallium-201 myocardial imaging. Am Jf Cardiol 1979;44: 1040-5.","journal-title":"Am Jf Cardiol"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/0002-9149(89)90428-1","article-title":"Significance of positive or negative thallium-201 scintigraphy in hypertrophic cardiomyopathy","volume":"64","author":"TW, Von Dohlen; LM, Prisant; MJ, Frank","year":"1989","unstructured":"Von Dohlen TW, Prisant LM, Frank MJ. Significance of positive or negative thallium-201 scintigraphy in hypertrophic cardiomyopathy. Am Jf Cardiol 1989;64:498-503.","journal-title":"Am Jf Cardiol"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1161\/01.CIR.71.2.234","article-title":"Myocardial ischemia in patients with hypertrophic cardiomyopathy: contribution of inadequate vasodilator reserve and elevated left ventricular filling pressures","volume":"71","author":"true","year":"1985","unstructured":"Cannon RO, Rosing DR, Maron BJ, Leon MB, Bonow RO, Watson MD, et al. Myocardial ischemia in patients with hypertrophic cardiomyopathy: contribution of inadequate vasodilator reserve and elevated left ventricular filling pressures. Circulation 1985;71:234-43.","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1161\/01.CIR.61.2.256","article-title":"Myocardial lactate extraction: multi-determined metabolic function","volume":"61","author":"Gertz, E.W.; Wisneski, J.A.; Neese, R.; Houser, A.; Korte, R.; Bristow, J.D.","year":"1980","unstructured":"Gertz EW, Wisneski JA, Neese R, Houser A, Korte R, Bristow JD. Myocardial lactate extraction: multi-determined metabolic function. Circulation 1980;61:256-61.","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1136\/hrt.47.4.369","article-title":"Continuous coronary sinus and arterial pH monitoring during pacing-induced ischaemia in coronary artery disease","volume":"47","author":"Cobbe, S.M.; Poole-Wilson, P.A.","year":"1982","unstructured":"Cobbe SM, Poole-Wilson PA. Continuous coronary sinus and arterial pH monitoring during pacing-induced ischaemia in coronary artery disease. Br Heart Jf 1982; 47:369-74.","journal-title":"Br Heart Jf"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3109\/03091908009161104","article-title":"Catheter tip pH electrodes for continuous intravascular recording","volume":"4","author":"Cobbe, S.M.; Poole-Wilson, P.A.","year":"1980","unstructured":"Cobbe SM, Poole-Wilson PA. Catheter tip pH electrodes for continuous intravascular recording. Journal of Medical Engineering and Technology 1980;4:122-4.","journal-title":"Journal of Medical Engineering and Technology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1136\/hrt.58.2.110","article-title":"Coronary sinus pH during percutaneous transluminal angioplasty: early development of acidosis during myocardial ischaemia in man","volume":"58","author":"Crake, T.; Crean, P.A.; Shapiro, L.M.; Rickards, A.F.; Poole-Wilson, P.A.","year":"1987","unstructured":"Crake T, Crean PA, Shapiro LM, Rickards AF, Poole-Wilson PA. Coronary sinus pH during percutaneous transluminal angioplasty: early development of acidosis during myocardial ischaemia in man. Br Heart J 1987; 58:110-5.","journal-title":"Br Heart J"},{"key":"ref_14","first-page":"672","article-title":"Report of the WHO\/IFSC task force on the definition and classification of cardiomyopathies","volume":"7","author":"44:","year":"1980","unstructured":"Report of the WHO\/IFSC task force on the definition and classification of cardiomyopathies. Br Heart J7 1980;44: 672-3.","journal-title":"Br Heart"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1161\/01.CIR.37.5.759","article-title":"Idiopathic hypertrophic subaortic stenosis: clinical analysis of 126 patients with emphasis on the natural history","volume":"37","author":"Frank, S.; Braunwald, E.","year":"1968","unstructured":"Frank S, Braunwald E. Idiopathic hypertrophic subaortic stenosis: clinical analysis of 126 patients with emphasis on the natural history. Circulation 1968;37:759-88.","journal-title":"Circulation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/S0735-1097(83)80269-1","article-title":"Distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy: a two dimensional echocardiographic study","volume":"2","author":"Shapiro, L.M.; McKenna, W.J.","year":"1983","unstructured":"Shapiro LM, McKenna WJ. Distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy: a two dimensional echocardiographic study. J Am Coll Cardiol 1983;2:437-44.","journal-title":"J Am Coll Cardiol"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/0002-9149(81)90068-0","article-title":"Patterns and significance of distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy. A wide angle, two dimensional echocardiographic study of 125 patients","volume":"48","author":"Maron, B.J.; Gottdiener, J.S.; Epstein, S.E.","year":"1981","unstructured":"Maron BJ, Gottdiener JS, Epstein SE. Patterns and significance of distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy. A wide angle, two dimensional echocardiographic study of 125 patients. Am Jf Cardiol 1981;48:418-28.","journal-title":"Am Jf Cardiol"},{"issue":"40","key":"ref_18","first-page":"185","article-title":"A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy","volume":"1969","author":"Romhilt, D.W.; Bove, K.E.; Norris, R.J.; Conyers, R.J.; Conradi, S.","unstructured":"Romhilt DW, Bove KE, Norris RJ, Conyers RJ, Conradi S. A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. Circulation 1969;40:185-95.","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1161\/01.CIR.82.6.1995","article-title":"Abnormal blood pressure response during exercise in hypertrophic cardiomyopathy","volume":"82","author":"Frenneaux, M.P.; Counihan, P.J.; Caforio, A.; Chikamori, T.; McKenna, W.J.","year":"1990","unstructured":"Frenneaux MP, Counihan PJ, Caforio A, Chikamori T, McKenna WJ. Abnormal blood pressure response during exercise in hypertrophic cardiomyopathy. Circulation 1990;82: 1995-2002.","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/0002-9149(93)90162-6","article-title":"Regional thallium-201 washout in hypertrophic cardiomyopathy and its relation to exertional chest pain","volume":"72","author":"Takata, J.; Counihan, P.J.; Gane, J.; Doi, Y.; Chikamori, T.; Ozawa, T.","year":"1993","unstructured":"Takata J, Counihan PJ, Gane J, Doi Y, Chikamori T, Ozawa T, et al. Regional thallium-201 washout in hypertrophic cardiomyopathy and its relation to exertional chest pain. Am J Cardiol 1993;72:211-7.","journal-title":"Am J Cardiol"},{"key":"ref_21","first-page":"353","article-title":"Correlation between myocardial thallium-201 kinetics, myocardial lactate metabolism and coronary angiographic findings in hypertrophic cardiomyopathy","volume":"69","author":"Hanrath, P.; Montz, R.; Mathey, D.; Theil, U.; Vorbringer, H.; Kupper, W.","year":"1980","unstructured":"Hanrath P, Montz R, Mathey D, Theil U, Vorbringer H, Kupper W, et al. Correlation between myocardial thallium-201 kinetics, myocardial lactate metabolism and coronary angiographic findings in hypertrophic cardiomyopathy. ZKardiol 1980;69:353-9.","journal-title":"ZKardiol"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1161\/01.CIR.63.6.1273","article-title":"Myocardial lactate metabolism: evidence of lactate release during net chemical extraction","volume":"63","author":"Gertz, E.W.; Wisneski, J.A.","year":"1981","unstructured":"Gertz EW, Wisneski JA. Myocardial lactate metabolism: evidence of lactate release during net chemical extraction. Circulation 1981;63:1273-9.","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/0002-9149(78)90165-0","article-title":"Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilatation","volume":"41","author":"Gould, K.L.","year":"1978","unstructured":"Gould KL. Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilatation. Am Jf Cardiol 1978;41:267-87.","journal-title":"Am Jf Cardiol"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S0735-1097(86)80181-4","article-title":"Intramural (\"small vessel\") coronary artery disease in hypertrophic cardiomyopathy","volume":"8","author":"Maron, B.J.; Wolfson, M.S.; Epstein, S.E.; Roberts, W.C.","year":"1986","unstructured":"Maron BJ, Wolfson MS, Epstein SE, Roberts WC. Intramural (\"small vessel\") coronary artery disease in hypertrophic cardiomyopathy. J Am Coll Cardiol 1986;8: 545-57.","journal-title":"J Am Coll Cardiol"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1161\/01.CIR.75.6.1130","article-title":"Quantitative analysis of narrowings of intramyocardial small arteries in normal hearts, hypertensive hearts, and hearts with hypertrophic cardiomyopathy","volume":"75","author":"Tanaka, M.; Fujiwara, H.; Onodera, T.; Wu, D.; Matsuda, M.; Hamashima, Y.","year":"1987","unstructured":"Tanaka M, Fujiwara H, Onodera T, Wu D, Matsuda M, Hamashima Y, et al. Quantitative analysis of narrowings of intramyocardial small arteries in normal hearts, hypertensive hearts, and hearts with hypertrophic cardiomyopathy. Circulation 1987;75:1130-9.","journal-title":"Circulation"},{"key":"ref_26","first-page":"62","article-title":"Transient myocardial ischaemia in hypertensives: tricular hypertrophy. Eur the missing link with left Heart Jf","volume":"venD):","author":"Scheler, S.; Motz, W.; Strauer, B.E.","year":"1992","unstructured":"Scheler S, Motz W, Strauer BE. Transient myocardial ischaemia in hypertensives: tricular hypertrophy. Eur the missing link with left Heart Jf 1992;13(suppl venD): 62-5."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1042\/cs0810703","article-title":"Abnormalities of the coronary circulation associated with left ventricular hypertrophy","volume":"81","author":"O'Gorman, D.J.; Sheridan, D.J.","year":"1991","unstructured":"O'Gorman DJ, Sheridan DJ. Abnormalities of the coronary circulation associated with left ventricular hypertrophy. Clin Sci 1991;81:703-13.","journal-title":"Clin Sci"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/hrt.75.2.179","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T11:44:41Z","timestamp":1758368681000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/hrt.75.2.179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,2]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1996,2,1]]},"published-print":{"date-parts":[[1996,2]]}},"alternative-id":["10.1136\/hrt.75.2.179"],"URL":"https:\/\/doi.org\/10.1136\/hrt.75.2.179","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[1996,2]]}}}