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Comparison of two software systems for quantification of myocardial blood flow in patients with hypertrophic

Hulya Yalcin1, Ines Valenta2, Min Zhao2,3

  • 1Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|January 24, 2018
PubMed

Insights

Software for quantifying myocardial blood flow (MBF) in hypertrophic cardiomyopathy (HCM) patients shows lower agreement between PMod and QPET. These MBF/MFR results indicate the softwares are not interchangeable for HCM analysis.

Area of Science:

  • Cardiovascular imaging
  • Nuclear cardiology
  • Medical physics

Background:

  • Myocardial blood flow (MBF) quantification using positron emission tomography (PET) is crucial for diagnosing angina in hypertrophic cardiomyopathy (HCM).
  • Existing MBF quantification software has primarily been validated in patients with normal cardiac anatomy, not in HCM patients who exhibit unique cardiac features like hyperdynamic left ventricular (LV) function and LV outflow tract (LVOT) obstruction.
  • Software performance evaluation in HCM is essential due to their distinct cardiac geometry and potential for LVOT obstruction.

Purpose of the Study:

  • To compare the myocardial blood flow (MBF) and myocardial flow reserve (MFR) quantification results between PMod and FDA-approved QPET software in patients with hypertrophic cardiomyopathy (HCM).
  • To assess the agreement of MBF and MFR values derived from PMod (manual segmentation) and QPET (automated segmentation) in HCM patients with specific cardiac characteristics.

Main Methods:

  • 13N-ammonia PET perfusion data were acquired at rest and during vasodilation in 76 HCM patients and 10 non-HCM controls.
  • MBF and MFR were calculated using both PMod and QPET software, with data resampled into static, ECG-gated, and dynamic formats.
  • Analysis included global and regional MBF/MFR values, with a focus on the impact of spillover fractions on software agreement.

Main Results:

  • PMod demonstrated significantly higher global and regional stress-MBF and MFR values compared to QPET in HCM patients.
  • Fair correlations were observed for global rest-MBF, stress-MBF, and MFR between PMod and QPET in HCM patients (r values ranging from 0.66 to 0.78).
  • Excluding HCM patients with high spillover fractions (>0.65) improved agreement between the softwares for MBF and MFR (r values up to 0.84). Non-HCM patients showed excellent agreement after exclusion.

Conclusions:

  • Anatomic characteristics specific to HCM hearts, such as asymmetric septal hypertrophy and LVOT obstruction, contribute to lower correlations between MBF/MFR values obtained by PMod and QPET.
  • The observed differences in quantification highlight that PMod and QPET software are not interchangeable for MBF/MFR analyses in HCM patients.
  • Further validation and potential algorithm adjustments may be needed for accurate MBF/MFR quantification in HCM using PET imaging software.
Abstract

Keywords:
Hypertrophic cardiomyopathyN-13 Ammonia PETmyocardial blood flowquantitative analysis

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