Higher incidence of vasodilator-induced left ventricular cavity dilation by PET when compared to treadmill exercise-ECHO in hypertrophic cardiomyopathy

Lu, Dai Yin; Yalçın, Hülya; Sivalokanathan, Sanjay; Greenland, Gabriela V.; Vasquez, Nestor; Yalçın, Fatih; Zhao, Min; Valenta, Ines; Ganz, Patricia A.; Pampaloni, Miguel Hernandez; Zimmerman, Stefan L.; Schindler, Thomas H.; Abraham, Theodore P.; Abraham, M. Roselle

doi:10.1007/s12350-018-01521-x

Cited by 6 publications

(5 citation statements)

References 34 publications

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“…In addition to MBF quantifications, we assessed LV function by means of gated PET and found the occurrence of abnormal LVEF reserve was in nearly a half of 89 HCM patients, consistent with two recent reports[16, 28]. Moreover, we showed a trend towards LVEF decrease after stress and blunted LVEF reserve, which appeared to be greater in those subjects with PH.…”

Section: Discussionsupporting

confidence: 89%

Association of PET-measured myocardial flow reserve with echocardiography-estimated pulmonary artery systolic pressure in patients with hypertrophic cardiomyopathy

et al. 2019

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BackgroundPulmonary hypertension (PH) is a known complication of HCM and is a strong predictor of mortality. We aim to investigate the relationship between microvascular dysfunction measured by quantitative PET and PH in HCM patients.MethodsEighty-nine symptomatic HCM patients were included in the study. Each patient underwent two 20-min 13N-NH3 dynamic PET scans for rest and stress conditions, respectively. A 2-tissue irreversible compartmental model was used to fit the segments time activity curves for estimating segmental and global myocardial blood flow (MBF) and myocardial flow reserve (MFR). Echocardiographic derived PASP was utilized to estimate PH.ResultsPatients were categorized into two groups across PASP: PH (PASP > 36 mmHg) and no-PH (PASP ≤ 36 mmHg). patients with PH had larger left atrium, ratio of higher inflow early diastole (E) and atrial contraction (A) waves, E/A, and ratio of inflow and peak early diastolic waves, E/e', significantly reduced global stress MBF (1.85 ± 0.52 vs. 2.13 ± 0.56 ml/min/g; p = 0.024) and MFR (2.21 ± 0.57 vs. 2.62 ± 0.75; p = 0.005), while the MBFs at rest between the two groups were similar. There were significant negative correlations between global stress MBF/MFR and PASP (stress MBF: r = -0.23, p = 0.03; MFR: r = -0.32, p = 0.002); for regional MBF and MFR measurements, the highest linear correlation coefficients were observed in the septal wall (stress MBF: r = -0.27, p = 0.01; MFR: r = -0.31, p = 0.003). Global MFR was identified to be independent predictor for PH in multivariate regression analysis.ConclusionEchocardiography-derived PASP is negatively correlated with global MFR measured by 13N-NH3 dynamic PET. Global MFR is suggested to be an index of PH in HCM patients.

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Section: Discussionsupporting

confidence: 89%

Association of PET-measured myocardial flow reserve with echocardiography-estimated pulmonary artery systolic pressure in patients with hypertrophic cardiomyopathy

et al. 2019

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“…In this scenario that consistently correlates TID with stress-induced MBF abnormalities and possibly ischemia in HCM patients, the results of the study by Lu et al published in this issue of the Journal of Nuclear Cardiology are somehow dissonant. 17 In a large patient population, whose overlap with those of previous studies by the same group is unclear, they did not find any relation between the presence of significant TID in perfusion PET and the results of exercise echocardiography. In particular, the patient group with TID [ 1.13 in dipyridamole PET showed no differences in the echocardiographic volumes after peak exercise from the patients without PET TID, and just one patient of the whole cohort showed post exercise TID in echocardiography.…”

Section: Vasodilator Pet Vs Exercise Echocardiographymentioning

confidence: 60%

Transient ischemic dilation in hypertrophic cardiomyopathy: A complex sign in a complex disease

Sciagrà

2020

Journal of Nuclear Cardiology

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“…A previous study reported the presence of TID on myocardial perfusion imaging was associated with the presence of severe CAD, but this association was modified by the presence of LVH and diabetes 26 . TID was also seen in patients with hypertrophic cardiomyopathy 27 . Notably, when we focused on subjects with ESV dilation, those who had CAD still had a greater extent of ESV dilation than those who did not.…”

Section: Discussionmentioning

confidence: 86%

“…This discrepancy implies that our study patients had less microvascular/ischemic fibrosis. Other than the etiology of obstructive macrovascular coronary disease, ESV dilation might also be associated with microvascular disease of LVH or diabetes 26,27 . A previous study reported the presence of TID on myocardial perfusion imaging was associated with the presence of severe CAD, but this association was modified by the presence of LVH and diabetes 26 .…”

Section: Discussionmentioning

confidence: 96%

Left ventricular end‐systolic volume response post‐stress echocardiography: Dilation as a marker of multi‐vessel coronary artery disease

Beyer

Pursnani

et al. 2022

Echocardiography

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Background Transient ischemic dilation of the left ventricle (LV) during stress echocardiography indicates extensive myocardial ischemia. It remains unclear whether the change of LV end‐systolic volume (ESV) or end‐diastolic volume (EDV) better correlated with significant coronary artery disease (CAD). Meanwhile, the clinical significance of the extent of the volumetric change post‐stress has not been investigated. Methods One hundred and five individuals (62 ± 12 years and 75% men) who underwent coronary angiography following exercise treadmill echocardiography were enrolled retrospectively. An additional 30 age‐ and sex‐matched healthy subjects were included for comparison. LV dilation was defined as any increase in LV volume from rest to peak exercise. Patients who had at least two coronary arteries with significant stenosis were considered as having multi‐vessel CAD. Results Thirty‐four patients had ESV dilation during exercise echocardiography. On the contrary, ESV decreased at peak exercise in all healthy subjects. Forty‐one patients had multi‐vessel CAD, and its prevalence was higher in patients with ESV dilation (65% vs 27%, p = 0.001). The extent of ESV increase correlated with CAD severity. ESV dilation is associated with multi‐vessel CAD (Odds ratio [OR] 5.02, 95% confidence interval [CI] 2.09 – 12.07, p < 0.001). After adjustment for EDV increase, clinical, electrocardiographic, and echocardiographic variables, the association remained significant (adjusted OR 5.57, 95% CI 1.37‐22.64; p = 0.02). Conclusions ESV dilation independently correlated with multi‐vessel CAD, whereas EDV dilation did not. The amount of ESV increase correlated with the severity of CAD. Our findings provide a rationale for incorporating volume measurements into stress echocardiography practice.

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Higher incidence of vasodilator-induced left ventricular cavity dilation by PET when compared to treadmill exercise-ECHO in hypertrophic cardiomyopathy

Cited by 6 publications

References 34 publications

Association of PET-measured myocardial flow reserve with echocardiography-estimated pulmonary artery systolic pressure in patients with hypertrophic cardiomyopathy

Association of PET-measured myocardial flow reserve with echocardiography-estimated pulmonary artery systolic pressure in patients with hypertrophic cardiomyopathy

Transient ischemic dilation in hypertrophic cardiomyopathy: A complex sign in a complex disease

Left ventricular end‐systolic volume response post‐stress echocardiography: Dilation as a marker of multi‐vessel coronary artery disease

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