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[Myocardial perfusion SPECT and isotopic ventriculography in obstructive and non-obstructive hypertrophic
G Romero-Farina1, J Candell-Riera, O Pereztol-Valdés
1Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Insights
Myocardial perfusion SPECT and radionuclide ventriculography do not predict outcomes in hypertrophic cardiomyopathy (HC). However, non-reversible defects correlate with ECG changes and indicate potential progression to dilated cardiomyopathy.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Imaging
Background:
- Hypertrophic cardiomyopathy (HC) is a complex condition affecting the heart muscle.
- Accurate prognostic tools are crucial for managing HC patients.
Purpose of the Study:
- To assess the prognostic value of myocardial perfusion single-photon emission computed tomography (SPET) and radionuclide ventriculography in patients with HC.
- To identify imaging markers associated with disease progression or adverse events.
Main Methods:
- Exercise myocardial perfusion SPET with 99mTc-tetrofosmin and radionuclide ventriculography were performed in 101 HC patients.
- Patients were followed for an average of 9.9 years, with a range of 1 to 28 years.
Main Results:
- Thirty-six percent of patients showed perfusion defects (15% non-reversible, 21% reversible).
- Non-reversible defects were more common in non-obstructive HC and associated with ECG abnormalities (pathologic Q waves), higher ventricular volumes, lower ejection fraction, and slower emptying velocity.
- No imaging variable predicted mortality, pacemaker implantation, or myectomy; however, syncope was linked to higher ejection fraction.
Conclusions:
- Myocardial perfusion SPET and radionuclide ventriculography lack prognostic value in HC.
- Non-reversible perfusion defects may indicate progression towards a dilated form of HC.
- Syncope in HC patients is associated with higher ejection fraction, but this finding lacks clear prognostic implication from the imaging modalities used.
Objective:
To evaluate the role of myocardial perfusion SPET and radionuclide ventriculography in patients with hypertrophic cardiomyopathy (HC).
Methods:
Exercise myocardial perfusion SPET with 99mTc-tetrofosmin and radionuclide ventriculography were performed in a consecutive series of 101 patients (54 15 years, 50 women, 55 with dynamic obstruction) diagnosed of HC by echo. Follow-up from the diagnosis was 9,9 6,7 years (1 to 28 years).
Results:
Thirty six percent of patients had perfusion defects (non reversible in 15 and reversible in 21). In non obstructive HC higher number of patients with non reversible defects (p = 0.01 was obseved and in patients with no reversible defects higher incidence of pathologic Q waves in ECG (p = 0.01), Higher ventricular volumes (p < 0.05), lower ejection fraction (p = 0,0001) and longer time to peak emptying velocity (p < 0.05). There were 4 cardiac deaths, 15 syncopes, 18 pacemakers and 6 myectomy. Ejection fraction was higher in patients with syncope (p = 0,034) and there was no isotopic variable predictive of mortality, pacemaker or myectomy.
Conclusions:
Neither SPET nor radionuclide ventriculography have a prognostic role in patients with HC, but patients with syncope have higher values of ejection fraction. Patients with non reversible defects have higher rate of pathologic Q waves in ECG, higher ventricular volumes and lower ejection fraction. This is indicative of evolution to dilated form of HC.