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PET-CT Imaging in Hypertrophic Cardiomyopathy: A Narrative Review on Risk Stratification and Prognosis
Patrícia Marques-Alves1,2, Lino Gonçalves1,2, Maria João Ferreira1,2,3,4
1Cardiology Department, Coimbra Hospital and University Center, 3004-561 Coimbra, Portugal.
Insights
Positron emission tomography (PET) shows promise in assessing hypertrophic cardiomyopathy (HCM) risks. Cardiac PET-CT imaging can improve sudden cardiac death (SCD) risk stratification and monitor treatment effectiveness in HCM patients.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Cardiomyopathy Research
Background:
- Hypertrophic cardiomyopathy (HCM) presents challenges in accurately stratifying sudden cardiac death (SCD) risk.
- Microvascular dysfunction, ischemia, and metabolic changes in HCM are linked to disease progression and adverse outcomes.
- Myocardial fibrosis and fibroblast activation are key factors in HCM progression.
Purpose of the Study:
- To review the role of cardiac PET-CT imaging in understanding HCM progression.
- To evaluate PET's utility in risk stratification for SCD in HCM patients.
- To explore PET's potential in monitoring therapeutic responses in HCM.
Main Methods:
- Utilizing Positron Emission Tomography (PET) to assess myocardial blood flow (MBF).
- Employing fluorodeoxyglucose (FDG) uptake to evaluate myocardial metabolism.
- Evaluating fibroblast activation using PET imaging for fibrosis assessment.
Main Results:
- PET can identify microvascular dysfunction, ischemia, and altered metabolism in HCM.
- Abnormal MBF and increased FDG uptake may correlate with increased SCD risk.
- PET imaging offers insights into myocardial fibrosis and fibroblast activation.
Conclusions:
- Cardiac PET-CT imaging provides valuable insights into HCM pathophysiology and progression.
- Further research is needed to confirm PET's role in enhancing SCD risk stratification for HCM.
- PET imaging holds potential for monitoring treatment efficacy and patient prognosis in HCM.
Abstract:
Hypertrophic cardiomyopathy (HCM) is a heterogeneous cardiac disease and one of its major challenges is the limited accuracy in stratifying the risk of sudden cardiac death (SCD). Positron emission tomography (PET), through the evaluation of myocardial blood flow (MBF) and metabolism using fluorodeoxyglucose (FDG) uptake, can reveal microvascular dysfunction, ischemia, and increased metabolic demands in the hypertrophied myocardium. These abnormalities are linked to several factors influencing disease progression, including arrhythmia development, ventricular dilation, and myocardial fibrosis. Fibroblast activation can also be evaluated using PET imaging, providing further insights into early-stage myocardial fibrosis. Conflicting findings underscore the need for further research into PET's role in risk stratification for HCM. If PET can establish a connection between parameters such as abnormal MBF or increased FDG uptake and SCD risk, it could enhance predictive accuracy. Additionally, PET holds significant potential for monitoring therapeutic outcomes. The aim of this review is to provide a comprehensive overview of the most significant data on disease progression, risk stratification, and prognosis in patients with HCM using cardiac PET-CT imaging.
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