Related Experiment Videos
A case of hypertensive-diabetic cardiomyopathy demonstrating left ventricular wall motion abnormality
T Shimonagata1, S Nanto, M Hori
1Department of Internal Medicine, Kansai Rosai Hospital, Hyogo, Japan.
Insights
Hypertensive-diabetic cardiomyopathy can cause left ventricular wall motion abnormalities. Impaired free fatty acid metabolism may contribute to this condition, alongside small-vessel coronary artery disease.
Area of Science:
- Cardiology
- Nuclear Medicine
- Metabolic Research
Background:
- Hypertensive-diabetic cardiomyopathy presents challenges in diagnosis.
- Coronary artery disease is a common cause of left ventricular dysfunction.
Observation:
- A patient with hypertensive-diabetic cardiomyopathy showed left ventricular regional wall motion abnormality.
- Coronary arteriography revealed normal coronary arteries.
- Dipyridamole-infusion 201Tl scintigraphy identified transient perfusion defects in the infero-posterior wall.
- Myocardial SPECT imaging with [123I]BMIPP and 201Tl showed reduced [123I]BMIPP uptake in the affected region.
Findings:
- Reduced myocardial free fatty acid metabolism was observed in the infero-posterior wall.
- This metabolic impairment correlated with regional wall motion abnormality.
- Transient perfusion defects were noted despite normal large coronary arteries.
Implications:
- Impaired myocardial free fatty acid metabolism may be an etiological factor in hypertensive-diabetic cardiomyopathy.
- Small-vessel coronary artery disease could play a role in the observed wall motion abnormalities.
- Nuclear imaging techniques like SPECT are valuable in assessing myocardial metabolism and perfusion.
Abstract:
We report a case of hypertensive-diabetic cardiomyopathy demonstrating left ventricular regional wall motion abnormality, with a normal coronary artery documented on coronary arteriography. Dipyridamole-infusion 201Tl scintigraphy demonstrated transient perfusion defects in the infero-posterior wall of the left ventricle, where reduced wall motion was demonstrated on contrast left ventriculography. Myocardial SPECT (single photon emission tomography) imaging with [123I] beta-methyliodophenylpentadecanoic acid (BMIPP) and 201Tl demonstrated reduced [123I]BMIPP uptake compared with 201Tl uptake in the infero-posterior wall of left ventricle. These results suggest that the impairment of myocardial free fatty acid metabolism is an etiologic or contributory factor for regional wall motion abnormality, together with small-vessel coronary artery disease, in this patient.