Do myocardial perfusion SPECT and radionuclide angiography studies in adult patients with hypertrophic cardiomyopathy have prognostic implications?

Romero-Farina, Guillermo; Candell‐Riera, Jaume; Galve, Enrique; Armadans, Lluı́s; Ramos, Francisca; Castell, Joan Martí i; Aguadé, S; Nogales, Juan; Soler‐Soler, Jordi

doi:10.1016/j.nuclcard.2004.05.008

Cited by 13 publications

(12 citation statements)

References 38 publications

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“…This is in agreement with previous studies demonstrating that absolute resting MBF is not different among segments with differing severities of myocardial wall thickening or LGE and between epi- and endocardial myocardium [32], [33]. Romero-Farina et al showed in a myocardial perfusion SPECT study that perfusion defects at rest were associated with a higher prevalence of severe complications, indicating the prognostic relevance of resting myocardial perfusion [12]. In our study, extent of LGE and presence of T2-signal abnormalities (T2 bright and T2 dark signal) independently predicted reduced resting perfusion.…”

Section: Discussionsupporting

confidence: 92%

“…For instance, a reduction of myocardial perfusion reserve at hyperemia or during exercise, indicating microvascular dysfunction, has frequently been described in HCM patients [12], [13], [15], [31]. Cecchi et al demonstrated its prognostic relevance in HCM: The degree of microvascular dysfunction was associated with worse prognosis and death [16].…”

Section: Discussionmentioning

confidence: 99%

“…They may be related to abnormal intramyocardial coronary arteries [11], inadequate capillary density in relation to increased myocardial mass or impairment of LV relaxation and may lead to myocardial ischemia and scarring. Nuclear medicine studies show that focal perfusion defects both at rest and during exercise are associated with arrhythmia, cardiac arrest and syncope in HCM patients [12], [13], [14], [15]. A higher degree of microvascular dysfunction has been shown to be an independent predictor for worse prognosis and death in HCM patients [16].…”

Section: Introductionmentioning

confidence: 99%

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In Hypertrophic Cardiomyopathy Reduction of Relative Resting Myocardial Blood Flow Is Related to Late Enhancement, T2-Signal and LV Wall Thickness

et al. 2012

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ObjectivesTo quantify resting myocardial blood flow (MBF) in the left ventricular (LV) wall of HCM patients and to determine the relationship to important parameters of disease: LV wall thickness, late gadolinium enhancement (LGE), T2-signal abnormalities (dark and bright signal), LV outflow tract obstruction and age.Materials and MethodsSeventy patients with proven HCM underwent cardiac MRI. Absolute and relative resting MBF were calculated from cardiac perfusion MRI by using the Fermi function model. The relationship between relative MBF and LV wall thickness, T2-signal abnormalities (T2 dark and T2 bright signal), LGE, age and LV outflow gradient as determined by echocardiography was determined using simple and multiple linear regression analysis. Categories of reduced and elevated perfusion in relation to non- or mildly affected reference segments were defined, and T2-signal characteristics and extent as well as pattern of LGE were examined. Statistical testing included linear and logistic regression analysis, unpaired t-test, odds ratios, and Fisher’s exact test.Results804 segments in 70 patients were included in the analysis. In a simple linear regression model LV wall thickness (p<0.001), extent of LGE (p<0.001), presence of edema, defined as focal T2 bright signal (p<0.001), T2 dark signal (p<0.001) and age (p = 0.032) correlated inversely with relative resting MBF. The LV outflow gradient did not show any effect on resting perfusion (p = 0.901). Multiple linear regression analysis revealed that LGE (p<0.001), edema (p = 0.026) and T2 dark signal (p = 0.019) were independent predictors of relative resting MBF. Segments with reduced resting perfusion demonstrated different LGE patterns compared to segments with elevated resting perfusion.ConclusionIn HCM resting MBF is significantly reduced depending on LV wall thickness, extent of LGE, focal T2 signal abnormalities and age. Furthermore, different patterns of perfusion in HCM patients have been defined, which may represent different stages of disease.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In Hypertrophic Cardiomyopathy Reduction of Relative Resting Myocardial Blood Flow Is Related to Late Enhancement, T2-Signal and LV Wall Thickness

et al. 2012

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“…The prevalence of both reversible and fixed perfusion abnormalities is quite common and has been reported to be between 20 and 75% [43][44][45][46][47]. Data from one of the largest series consisting of 102 patients with HCM (mean age 54 AE 16 years, 56% men, 55% obstructive) reported 54% prevalence of perfusion abnormalities [46].…”

Section: Nuclear Cardiac Imaging In the Assessment Of Myocardial Ischmentioning

confidence: 99%

“…Data from one of the largest series consisting of 102 patients with HCM (mean age 54 AE 16 years, 56% men, 55% obstructive) reported 54% prevalence of perfusion abnormalities [46]. Presence and severity of perfusion abnormalities have also been shown to prognosticate subsequent impaired left ventricular systolic function [45] and unfavorable outcomes such as sudden cardiac death [46][47][48][49][50].…”

Section: Nuclear Cardiac Imaging In the Assessment Of Myocardial Ischmentioning

confidence: 99%

Diagnosis of ischemia in hypertrophic cardiomyopathy

Chaikriangkrai

Chebrolu

Bhatti

et al. 2015

Current Opinion in Cardiology

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Prognostic Significance of Myocardial Ischemia Detected by Single-Photon Emission Computed Tomography in Children with Hypertrophic Cardiomyopathy

et al. 2021

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Myocardial ischemia caused by microvascular dysfunction is an important pathophysiologic component of hypertrophic cardiomyopathy (HCM), promoting myocardial fibrosis, adverse left ventricular remodeling, and impacting on clinical course and outcome in HCM patients. The aim of study was to assess the prevalence and clinical significance of myocardial ischemia in children with HCM using 99mTc-MIBI single-photon emission computed tomography (SPECT). Ninety-one children with HCM, median age 13.6 years, underwent SPECT evaluation from 2006 to 2017. Imaging was performed at rest and after maximal exercise. Myocardial perfusion defects were identified in 70 children (76.9%; group I), median age 13.8 years. Fixed perfusion defects were evident in 22 of them, while reversible at rest in 48. In 21 children (23.1%; group II), median age 11 years, myocardial perfusion defects were not detected. Patient demographics, echocardiography, resting electrocardiogram (ECG), 24-h Holter ECG, myocardial fibrosis in cardiovascular magnetic resonance imaging, and cardiovascular events were analyzed and compared between the groups. During follow-up at a median of 8.3 years in children with myocardial ischemia, clinical endpoints occurred more often (47 vs. 5; p = 0.02) and more patients reached a clinical endpoint (28 [40%] vs. 3 [14.3%]; p = 0.036). In children with myocardial ischemia, myocardial fibrosis was observed with greater frequency. Myocardial perfusion defects may reflect an ischemic process which (1) affects the clinical manifestations and (2) is an important predictor of adverse clinical events and risk of death in children with HCM. Myocardial ischemia in HCM patients frequently correlates with myocardial fibrosis.

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Do myocardial perfusion SPECT and radionuclide angiography studies in adult patients with hypertrophic cardiomyopathy have prognostic implications?

Cited by 13 publications

References 38 publications

In Hypertrophic Cardiomyopathy Reduction of Relative Resting Myocardial Blood Flow Is Related to Late Enhancement, T2-Signal and LV Wall Thickness

In Hypertrophic Cardiomyopathy Reduction of Relative Resting Myocardial Blood Flow Is Related to Late Enhancement, T2-Signal and LV Wall Thickness

Diagnosis of ischemia in hypertrophic cardiomyopathy

Prognostic Significance of Myocardial Ischemia Detected by Single-Photon Emission Computed Tomography in Children with Hypertrophic Cardiomyopathy

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