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European Journal of Nuclear Medicine and Molecular Imaging

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01-05-2017 | Original Article

Myocardial blood flow and left ventricular functional reserve in hypertrophic cardiomyopathy: a ¹³NH₃ gated PET study

Authors: Roberto Sciagrà, Raffaella Calabretta, Fabrizio Cipollini, Alessandro Passeri, Angelo Castello, Franco Cecchi, Iacopo Olivotto, Alberto Pupi

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 5/2017

Abstract

Introduction

Ischemia in hypertrophic cardiomyopathy (HCM) is caused by coronary microvascular dysfunction (CMD), which is detected by measuring myocardial blood flow (MBF) with PET. Whether CMD may be associated with ischemic left ventricular (LV) dysfunction is unclear. We therefore assessed LV ejection fraction (EF) reserve in HCM patients undergoing dipyridamole (Dip) PET.

Methods

Resting and stress ¹³NH₃ dynamic as well as gated PET were performed in 34 HCM patients. Segmental MBF and transmural perfusion gradient (TPG = subendocardial / subepicardial MBF) were assessed. LVEF reserve was considered abnormal if Dip LVEF decreased more than 5 units as compared to rest.

Results

Eighteen patients had preserved (group A) and 16 abnormal LVEF reserve (group B; range −7 to −32). Group B patients had greater wall thickness than group A, but resting volumes, LVEF, resting and Dip MBF, and myocardial flow reserve were similar. Group B had slightly higher summed stress score and summed difference score in visual analysis than group A, and a significantly higher summed stress wall motion score. In group B, resting TPG was slightly lower (1.31 ± 0.29 vs. 1.37 ± 0.34, p <0.05), and further decreased after Dip, whilst in group A it increased (B = 1.20 ± 0.39, p < 0.0001 vs. rest and vs. A = 1.40 ± 0.43). The number of segments per patient with TPG <1 was higher than in group A (p < 0.001) and was a significant predictor of impaired LVEF reserve (OR 1.86, p < 0.02), together with wall thickness (OR 1.3, p < 0.02).

Conclusion

Abnormal LVEF response is common in HCM patients following Dip, and is related to abnormal TPG, suggesting that subendocardial ischemia might occur under Dip and cause transient LV dysfunction. Although in vivo this effect may be hindered by the adrenergic drive associated with effort, these findings may have relevance in understanding exercise limitation and heart failure symptoms in HCM.

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Title: Myocardial blood flow and left ventricular functional reserve in hypertrophic cardiomyopathy: a 13NH3 gated PET study
Authors: Roberto Sciagrà
Raffaella Calabretta
Fabrizio Cipollini
Alessandro Passeri
Angelo Castello
Franco Cecchi
Iacopo Olivotto
Alberto Pupi
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 5/2017
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-016-3603-2

At a glance: The STEP trials

Springer Medicine

Myocardial blood flow and left ventricular functional reserve in hypertrophic cardiomyopathy: a ¹³NH₃ gated PET study

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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