Idiopathic hypertrophic subaortic stenosis: Evaluation of anginal symptoms with thallium-201 myocardial imaging

Rubin, Kenneth A.; Morrison, John; Padnick, Marvin B.; Binder, Alan J.; Chiaramida, Salvatore A.; Margouleff, Donald; Padmanabhan, Venkat; Gulotta, Stephen J.

doi:10.1016/0002-9149(79)90166-8

Cited by 59 publications

(9 citation statements)

References 25 publications

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“…Thus, the verapamil dosage at the time of repeat study ranged from 240 to 480 mg/day (mean, 453), and this dosage was maintained for a mean of 6.7 days (range, 2-56) before the repeat study. The verapamil studies were performed [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] weeks (mean, 6±5) after the initial control studies.…”

Section: Study Protocolmentioning

confidence: 99%

Verapamil prevents silent myocardial perfusion abnormalities during exercise in asymptomatic patients with hypertrophic cardiomyopathy.

et al. 1989

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Recent studies indicate that reversible 201Tl perfusion defects, compatible with silent myocardial ischemia, commonly develop during exercise in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy (HCM). To determine whether this represents a dynamic process that may be modified favorably by medical therapy, we studied 29 asymptomatic or minimally symptomatic patients with HCM, aged 12-55 years (mean, 28), with exercise 201Tl emission computed tomography under control conditions and again after 1 week of oral verapamil (mean dosage, 453 mg/day). Treadmill time increased slightly during verapamil (21.0 +/- 3.6 to 21.9 +/- 2.7 minutes, p less than 0.005), but peak heart rate-blood pressure product was unchanged (26.3 +/- 6.0 X 10(3) compared with 25.0 +/- 6.4 X 10(3). Two midventricular short-axis images per study were divided into five regions each, and each of these 10 regions was then analyzed on a 0-2 scale by three observers blinded with regard to the patients' therapy. Average regional scores of 1.5 or less were considered to represent perfusion defects, and a change in regional score of 0.5 or more was considered to constitute a significant change. During control studies, 15 patients (52%) developed perfusion defects with exercise (average, 3.7 regions per patient). In 14 of these patients, all perfusion defects completely reversed after 3 hours of rest; one patient had fixed defects. After administration of verapamil, exercise perfusion scores improved in 10 of the 14 patients (71%) with reversible defects; there was overall improvement in 34 of 50 (68%) regions with initially reversible perfusion defects.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Study Protocolmentioning

confidence: 99%

Verapamil prevents silent myocardial perfusion abnormalities during exercise in asymptomatic patients with hypertrophic cardiomyopathy.

et al. 1989

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“…Although perfusion defects on thallium-201 singlephoton emission computed tomography (SPECT) were convincingly shown in HCM patients more than 25 years ago (27,28), assessment of myocardial ischemia is currently not part of routine clinical diagnostic or management strategies in this disease (4). This limitation almost certainly impacts our capability for providing a more comprehensive evaluation of individual HCM patients.…”

mentioning

confidence: 99%

The Case for Myocardial Ischemia in Hypertrophic Cardiomyopathy

Maron

Olivotto

Maron

et al. 2009

Journal of the American College of Cardiology

260

200

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Since its original description 50 years ago, myocardial ischemia has been a recognized but underappreciated aspect of the pathophysiology of hypertrophic cardiomyopathy (HCM). Nevertheless, the assessment of myocardial ischemia is still not part of routine clinical diagnostic or management strategies. Morphologic abnormalities of the intramural coronary arterioles represent the primary morphologic substrate for microvascular dysfunction and its functional consequence-that is, blunted myocardial blood flow (MBF) during stress. Recently, a number of studies using contemporary cardiovascular imaging modalities such as positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) have led to an enhanced understanding of the role that myocardial ischemia and its sequelae fibrosis play on clinical outcome. In this regard, studies with PET have shown that HCM patients have impaired MBF after dipyridamole infusion and that this blunted MBF is a powerful independent predictor of cardiovascular mortality and adverse LV remodeling associated with LV systolic dysfunction. Stress CMR with late gadolinium enhancement (LGE) has also shown that MBF is reduced in relation to magnitude of wall thickness and in those LV segments occupied by LGE (i.e., fibrosis). These CMR observations show an association between ischemia, myocardial fibrosis, and LV remodeling, providing support that abnormal MBF caused by microvascular dysfunction is responsible for myocardial ischemia-mediated myocyte death, and ultimately replacement fibrosis. Efforts should now focus on detecting myocardial ischemia before adverse LV remodeling begins, so that interventional treatment strategies can be initiated earlier in the clinical course to mitigate ischemia and beneficially alter the natural history of HCM.

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“…Thallium has been used to assess ischemia in patients with HCM [16]. Initial expe rience with ultrafast CT has demonstrated that myocar dial blood flow correlates well with radioactive micro sphere measurement demonstrated by our group [42,43].…”

Section: Discussionmentioning

confidence: 81%

“…MUGA studies have been used to evaluate systolic and diastolic function, and wall motion [12,15]. Thallium has been used to evaluate abnormal perfusion in patients with HCM [16]. Single photon emission computed to mography (SPECT), currently becoming more available, overcomes the problem of superimposition experienced by MUGA and thallium.…”

mentioning

confidence: 99%

Ultrafast Computed Tomography: A New Method for the Evaluation of Hypertrophic Cardiomyopathy

Chomka¹,

Wolfkiel²,

Rich³

et al. 1987

Am J Noninvas Cardiol

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Hypertrophic cardiomyopathy (HCM) presents with a wide spectrum of heterogeneous morphology. Modalities used to assess HCM include echocardiography, cardiac catheterization, radionuclide angiography, conventional computed tomography (CT), and magnetic resonance imaging. This investigation was performed to assess the feasibility of using ultrafast CT with 50 ms/scan acquisition time in the cine mode to compare 11 patients with HCM to 11 patients with normal studies. A specific advantage of this technique includes tomographic representation of ventricular anatomy coupled with the ability to evaluate multiple parameters of dynamic function. Global and tomographic ejection fraction, left ventricular mass, wall thickness, left atrial size, and diastolic filling rates are among the parameters that can be measured. Mitral valve motion can also be assessed. Comparisons were made between the HCM and normal groups using a sample t test. There was a significant difference in left ventricular mass (p < 0.05) between the groups. Specific wall thickness parameters were also measured. Comparisons of the septal basal, septal mid-left ventricular, anterior basal, anterior mid-left ventricular, lateral, and posterior walls revealed a significant difference (p < 0.05). The left atrial dimensions also demonstrated a significant difference (p < 0.05). Quantitative assessment of HCM can be performed by ultrafast CT. The combination of excellent spatial and temporal resolution makes it competitive and potentially superior to other techniques. Ultrafast CT should be considered when confronted with the need for diagnostic evaluation and subsequent follow-up in HCM.

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Idiopathic hypertrophic subaortic stenosis: Evaluation of anginal symptoms with thallium-201 myocardial imaging

Cited by 59 publications

References 25 publications

Verapamil prevents silent myocardial perfusion abnormalities during exercise in asymptomatic patients with hypertrophic cardiomyopathy.

Verapamil prevents silent myocardial perfusion abnormalities during exercise in asymptomatic patients with hypertrophic cardiomyopathy.

The Case for Myocardial Ischemia in Hypertrophic Cardiomyopathy

Ultrafast Computed Tomography: A New Method for the Evaluation of Hypertrophic Cardiomyopathy

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