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[Myocardial perfusion abnormality and chest pain in patients with hypertrophic cardiomyopathy]
M Narita1, T Kurihara, K Murano
1Department of Internal Medicine, Sumitomo Hospital.
Insights
Myocardial ischemia plays a role in chest pain for hypertrophic cardiomyopathy (HCM) patients. Exercise stress SPECT revealed perfusion abnormalities in HCM, increasing with chest pain severity.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex condition often presenting with chest pain.
- The underlying cause of chest pain in HCM, particularly the role of myocardial ischemia, requires further investigation.
- Normal coronary arteries in HCM patients with chest pain suggest non-obstructive causes.
Purpose of the Study:
- To investigate the role of myocardial ischemia in chest pain development in hypertrophic cardiomyopathy (HCM) patients.
- To correlate myocardial perfusion defects with chest pain severity and functional class in HCM.
- To utilize exercise stress thallium-201 SPECT to assess myocardial perfusion in HCM.
Main Methods:
- 27 HCM patients underwent exercise stress (Ex) redistribution myocardial single photon emission CT (SPECT) using thallium-201 (Tl).
- Patients were classified into NYHA Class I, II, and III based on chest pain frequency and severity.
- Myocardial perfusion patterns were categorized into normal, no defect/abnormal washout, reversible defect, fixed defect/abnormal washout, and fixed defect/normal washout.
Main Results:
- In NYHA Class I, 64% showed normal perfusion; others had abnormalities (no defect/abnormal washout or reversible defect).
- All patients in NYHA Class II and III exhibited perfusion abnormalities (reversible defect, fixed defect/abnormal washout, or fixed defect/normal washout).
- Perfusion abnormalities were most common in the anterior (35%), inferior/posterior (20%), and septal (18%) walls.
Conclusions:
- Myocardial ischemia, as detected by SPECT, is associated with chest pain in HCM patients.
- Perfusion abnormalities are prevalent in HCM patients, particularly those with higher functional class and more severe chest pain.
- Exercise stress SPECT is a valuable tool for evaluating myocardial perfusion and its relationship to symptoms in HCM.
Abstract:
To investigate the role of myocardial ischemia in the development of chest pain in patients with hypertrophic cardiomyopathy (HCM), exercise stress (Ex) redistribution myocardial single photon emission CT's (SPECT's) with thallium-201 (Tl) were obtained in 27 patients with HCM. In all patients, coronary arteries were normal arteriographically. Patients were classified into NYHA Class I, II and III according to the frequency and severity of the chest pain during daily life. In these 3 groups, age, sex and intraventricular septal thickness measured by echocardiography were not different. Types of myocardial perfusion obtained by myocardial SPECT's were divided into 5: 1) normal perfusion, 2) no perfusion defect with abnormal myocardial Tl washout rate (WOR) during 3 hours (less than 30%) [Def(-)/WORabn], 3) reversible perfusion defect (RD), 4) fixed defect with abnormal WOR (FD/WORabn), 5) fixed defect with normal WOR (FD/WORnl). In 14 patients with Class I, 9 patients (64%) showed normal perfusion but the rest showed perfusion abnormality (def(-)/WORabn in 3 and RD in 2). In Class II and III, all patients showed perfusion abnormalities of RD, FD/WORabn or FD/WORnl. As the functional class progressed from Class II to III, the ratio of fixed defect (both WORnl and WORabn) to RD increased, but it was not statistically significant. In 2 patients in whom Ex SPECT's were repeated because of the progression of the chest pain, the severity of the perfusion abnormality also progressed. Perfusion abnormalities were observed most frequently in anterior (35%), then inferior/posterior (20%) and septal wall (18%).(ABSTRACT TRUNCATED AT 250 WORDS)