Regional heterogeneity of resting perfusion in hypertrophic cardiomyopathy is related to delayed contrast enhancement but not to systolic function: A PET and MRI study

Knaapen, Paul; Dockum, Willem G. van; Götte, Marco J.W.; Broeze, Kimiko A.; Kuijer, Joost P.A.; Zwanenburg, Jaco J.M.; Marcus, J. Tim; Kok, Wouter E.; Rossum, Albert C. van; Lammertsma, Adriaan A.; Visser, Frans C.

doi:10.1016/j.nuclcard.2006.05.018

Cited by 36 publications

(23 citation statements)

References 33 publications

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“…Knaapen et al demonstrated a significant inverse correlation between DCE extent and degree of regional systolic function and the lack of any relationship between resting MBF and regional function (24). In our series, we confirmed their findings by demonstrating an inverse relationship between DCE severity and ES thickening but also registered a significant direct correlation between this parameter and hMBF.…”

Section: Discussionsupporting

confidence: 89%

“…When marked, fibrosis is thought to represent one of the relevant substrates for end-stage progression and heart failure (35), as well as sudden cardiac death (36,37). Recently, Knaapen et al observed that the extent of DCE in patients with HCM was inversely related to absolute resting perfusion, measured by 15 O-labeled tracers (24). The authors concluded that regional heterogeneity of resting perfusion is related to the extent of fibrosis (24).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Knaapen et al observed that the extent of DCE in patients with HCM was inversely related to absolute resting perfusion, measured by 15 O-labeled tracers (24). The authors concluded that regional heterogeneity of resting perfusion is related to the extent of fibrosis (24). In a previous study, however, the same authors had demonstrated that the water-perfusable tissue index was not decreased in the septum of patients with HCM with DCE and concluded that fibrosis is not the sole cause of DCE in these patients (23).…”

Section: Discussionmentioning

confidence: 99%

“…Myocardial scarring can be visualized as delayed contrast enhancement (DCE) within the left ventricle by MRI (15,16,22). To date, few studies have compared baseline MBF and DCE in HCM (23,24), and to our knowledge, no data assessing the spatial relationship between hMBF and DCE exist. Therefore, the pathophysiologic relationship between coronary microvascular dysfunction and fibrosis remains elusive.…”

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confidence: 99%

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Spatial Relationship Between Coronary Microvascular Dysfunction and Delayed Contrast Enhancement in Patients with Hypertrophic Cardiomyopathy

Sotgia¹,

Sciagrà²,

Olivotto³

et al. 2008

J Nucl Med

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To clarify the spatial relationship between coronary microvascular dysfunction and myocardial fibrosis in hypertrophic cardiomyopathy (HCM), we compared the measurement of hyperemic myocardial blood flow (hMBF) by PET with the extent of delayed contrast enhancement (DCE) detected by MRI. Methods: In 34 patients with HCM, PET was performed using 13 N-labeled ammonia during hyperemia induced by intravenous dipyridamole. DCE and systolic thickening were assessed by MRI. Left ventricular myocardial segments were classified as with DCE, either transmural (DCE-T) or nontransmural (DCE-NT), and without DCE, either contiguous to DCE segments (NoDCE-C) or remote from them (NoDCE-R). Results: In the group with DCE, hMBF was significantly lower than in the group without DCE (1.81 6 0.94 vs. 2.13 6 1.11 mL/min/g; P , 0.001). DCE-T segments had lower hMBF than did DCE-NT segments (1.43 6 0.52 vs. 1.91 6 1 mL/min/g, P , 0.001). Similarly, NoDCE-C segments had lower hMBF than did NoDCE-R (1.98 6 1.10 vs. 2.29 6 1.10 mL/min/g, P , 0.01) and had no significant difference from DCE-NT segments. Severe coronary microvascular dysfunction (hMBF in the lowest tertile of all segments) was more prevalent among NoDCE-C than NoDCE-R segments (33% vs. 24%, P , 0.05). Systolic thickening was inversely correlated with percentage transmurality of DCE (Spearman r 5 20.37, P , 0.0001) and directly correlated with hMBF (Spearman r 5 0.20, P , 0.0001). Conclusion: In myocardial segments exhibiting DCE, hMBF is reduced. DCE extent is inversely correlated and hMBF directly correlated with systolic thickening. In segments without DCE but contiguous to DCE areas, hMBF is significantly lower than in those remote from DCE and is similar to the value obtained in nontransmural DCE segments. These results suggest that increasing degrees of coronary microvascular dysfunction might play a causative role for myocardial fibrosis in HCM.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Spatial Relationship Between Coronary Microvascular Dysfunction and Delayed Contrast Enhancement in Patients with Hypertrophic Cardiomyopathy

Sotgia¹,

Sciagrà²,

Olivotto³

et al. 2008

J Nucl Med

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“…Regional efficiency HCM hearts exhibit marked heterogeneity in regional contractile properties [36][37][38]. Correspondingly, we have shown that septal E cc was significantly decreased as compared to the lateral wall in the HCM group.…”

Section: Myocardial Efficiencymentioning

confidence: 50%

Determinants of myocardial energetics and efficiency in symptomatic hypertrophic cardiomyopathy

Timmer

Germans

Götte

et al. 2010

Eur J Nucl Med Mol Imaging

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Purpose Next to hypertrophy, hypertrophic cardiomyopathy (HCM) is characterized by alterations in myocardial energetics. A small number of studies have shown that myocardial external efficiency (MEE), defined by external work (EW) in relation to myocardial oxidative metabolism (MVO 2 ), is reduced. The present study was conducted to identify determinants of MEE in patients with HCM by use of dynamic positron emission tomography (PET) and cardiovascular magnetic resonance imaging (CMR). Methods Twenty patients with HCM (12 men, mean age: 55.2 ± 13.9 years) and 11 healthy controls (7 men, mean age: 48.1 ± 10 years) were studied with [ 11 C]acetate PET to assess MVO 2 . CMR was performed to determine left ventricular (LV) volumes and mass (LVM). Univariate and multivariate analyses were employed to determine independent predictors of myocardial efficiency.Results Between study groups, MVO 2 (controls: 0.12 ± 0.04 ml·min −1 ·g −1 , HCM: 0.13 ± 0.05 ml·min −1 ·g −1 , p = 0.64) and EW (controls: 9,139 ± 2,484 mmHg·ml, HCM: 9,368 ± 2,907 mmHg·ml, p = 0.83) were comparable, whereas LVM was significantly higher (controls: 99 ± 21 g, HCM: 200 ± 76 g, p < 0.001) and MEE was decreased in HCM patients (controls: 35 ± 8%, HCM: 21 ± 10%, p < 0.001). MEE was related to stroke volume (SV), LV outflow tract gradient, NH 2 -terminal pro-brain natriuretic peptide (NT-proBNP) and serum free fatty acid levels (all p < 0.05). Multivariate analysis revealed that SV (ß = 0.74, p < 0.001) and LVM (ß = −0.43, p = 0.013) were independently related to MEE. Conclusion HCM is characterized by unaltered MVO 2 , impaired EW generation per gram of myocardial tissue and subsequent deteriorated myocardial efficiency. Mechanical external efficiency could independently be predicted by SV and LVM.

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Delayed enhancement in hypertrophic cardiomyopathy: Comparison with myocardial tagging MRI

Kim¹,

Choi²,

Hur³

et al. 2008

Magnetic Resonance Imaging

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Purpose: To evaluate the relationship between delayed enhancement (DE) and regional left ventricular function in hypertrophic cardiomyopathy (HCM) using gadolinium enhancement MRI and myocardial tagging MRI. Materials and Methods:Cine imaging, delayed enhancement imaging, and tagging MRI were performed in 25 patients with HCM. The location, pattern, and extent of DE were evaluated. Circumferential shortening (Ecc) was obtained by analyzing MR tagging images with HARP software.Results: DE occurred in 21 (84%) patients with a high frequency of localization in the septum and the right ventricular attachment sites. Circumferential shortening was significantly decreased in the enhanced segments compared with nonenhanced segments (P Ͻ 0.0001). The myocardial wall was thicker in the enhanced segments than in the nonenhanced segments (P Ͻ 0.0001). However, circumferential shortening was significantly decreased in the enhanced segments of the same thickness (P Ͻ 0.0001). Circumferential shortening was more substantially impaired in the segments with focal nodular enhancement than those in the segments with ill-defined patchy enhancement (P ϭ 0.0002). Conclusion:In HCM, DE is commonly found and circumferential shortening is significantly impaired in the regions with DE, regardless of the degree of myocardial hypertrophy. Focal nodular enhancement is particularly related with regional dysfunction in patients with HCM. HYPERTROPHIC CARDIOMYOPATHY (HCM) is a genetic disorder that is histologically characterized by myocyte disarray, interstitial fibrosis, and small vessel disease (1,2). Studies using gadolinium enhancement MRI have reported that delayed myocardial enhancement (DE) may be seen in patients with HCM and is positively correlated with myocardial wall thickness (3-6). A recent report revealed that DE is related to myocardial collagen, which is a major component of fibrosis (7).Regional heterogeneity of left ventricular function in HCM has been reported, and circumferential strain or systolic wall thickening is often decreased in hypertrophied areas (8 -13). However, the relationship between DE and regional performance has not been established. The purpose of our study is to evaluate the prevalence and pattern of DE in HCM and to determine the relationship between DE and regional performance using gadolinium enhancement MRI and tagged MRI. MATERIALS AND METHODS Patient PopulationThe study population consisted of 25 patients (M:F ϭ 19:6; mean age, 48.6 years old; range, 22-68 years) who were diagnosed with HCM by echocardiography and referred for MRI. We included the patients who met the following criteria: (i) the presence of a hypertrophied left ventricle (LV; Ͼ15 mm in thickness on echocardiography), (ii) normal coronary arteries as determined by conventional coronary angiography or coronary MR angiography, and (iii) no secondary causes of hypertrophy such as severe aortic valvular disease or hypertension. The study protocol was approved by the institutional review board.

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Regional heterogeneity of resting perfusion in hypertrophic cardiomyopathy is related to delayed contrast enhancement but not to systolic function: A PET and MRI study

Abstract: Regional heterogeneity of resting perfusion in HCM is related to the extent of DCE but not to regional systolic function.

Cited by 36 publications

References 33 publications

Spatial Relationship Between Coronary Microvascular Dysfunction and Delayed Contrast Enhancement in Patients with Hypertrophic Cardiomyopathy

Spatial Relationship Between Coronary Microvascular Dysfunction and Delayed Contrast Enhancement in Patients with Hypertrophic Cardiomyopathy

Determinants of myocardial energetics and efficiency in symptomatic hypertrophic cardiomyopathy

Delayed enhancement in hypertrophic cardiomyopathy: Comparison with myocardial tagging MRI

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