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Apparent left ventricular cavity dilatation during PET/CT in hypertrophic cardiomyopathy: Clinical predictors and potential mechanisms

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Apparent left ventricular cavity dilatation (LVCD) in patients with hypertrophic cardiomyopathy (HCM) is an incompletely understood phenomenon. We aimed at investigating its clinical predictors and potential mechanisms.

Methods

Sixty one HCM patients underwent N-13-ammonia PET for visual evaluation of LVCD, transient ischemic dilatation (TID) index, myocardial blood flow (MBF), coronary flow reserve (CFR), and regional myocardial perfusion (rMP). TID index was also derived at 2–4 and 15–20 minutes.

Results

Visual LVCD and quantitative TID (>1.13 abnormal) agreement were excellent (k 0.91; P < .0001). LVCD-positive (n = 32) patients had greater LV thickness (2.26 ± 0.59 vs 1.92 ± 0.41 cm; P = .005), but lower stress MBF (1.66 ± 0.42 vs 2.07 ± 0.46 mL/minute/g; P < .0001), and CFR (1.90 ± 0.46 vs 2.46 ± 0.69; P < .0001) than LVCD-negative (n = 29) patients. Abnormal rMP was present in 31/32 LVCD-positive but only 12/29 (P < .0001) LVCD-negative. TID index was higher at 2–4 (1.30 ± 0.13) than at 15–20 minutes (1.27 ± 0.12; P = .001) in LVCD-positive, whereas it was the same (1.04 ± 0.07 vs 1.04 ± 0.07; P = .9) in LVCD-negative. In multivariate analysis, global peak MBF, abnormal rMP, and LV thickness were the best predictors of LVCD.

Conclusion

Apparent LVCD is a common finding in HCM, intimately related to abnormal myocardial perfusion, globally impaired vasodilator flow reserve, and degree of hypertrophy. In addition to regional and/or diffuse subendocardial ischemia, some degree of true LV chamber dilatation may also contribute to the occurrence of apparent LVCD in HCM.

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Abbreviations

HCM:

Hypertrophic cardiomyopathy

LVCD:

Left ventricular cavity dilatation

MBF:

Myocardial blood flow

CFR:

Coronary flow reserve

TID:

Transient ischemic dilatation

PM:

Papillary muscles

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Disclosure

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Johns Hopkins University, Baltimore, MD, USA

    Paco E. Bravo MD, Abdel Tahari MD, PhD & Richard L. Wahl MD

  2. Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA

    Iraklis Pozios MD, Hong-Chang Luo MD, M. Roselle Abraham MD & Theodore P. Abraham MD

  3. Division of Cardiology, University of Washington, 1959 NE Pacific St., HSB AA522, Seattle, WA, 98133, USA

    Paco E. Bravo MD

  4. Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany

    Frank M. Bengel MD

Authors
  1. Paco E. Bravo MD
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  2. Abdel Tahari MD, PhD
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  3. Iraklis Pozios MD
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  4. Hong-Chang Luo MD
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  5. Frank M. Bengel MD
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  6. Richard L. Wahl MD
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  7. M. Roselle Abraham MD
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  8. Theodore P. Abraham MD
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Correspondence to Paco E. Bravo MD.

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See related editorial, doi:10.1007/s12350-015-0180-x.

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Bravo, P.E., Tahari, A., Pozios, I. et al. Apparent left ventricular cavity dilatation during PET/CT in hypertrophic cardiomyopathy: Clinical predictors and potential mechanisms. J. Nucl. Cardiol. 23, 1304–1314 (2016). https://doi.org/10.1007/s12350-015-0158-8

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  • DOI: https://doi.org/10.1007/s12350-015-0158-8

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