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Myocardial perfusion SPECT in the diagnosis of apical hypertrophic cardiomyopathy

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Abstract

Background

Apical hypertrophy cardiomyopathy (ACM) is a rare condition characterized by asymmetric myocardial hypertrophy of the apex of the left ventricle. When two-dimensional echocardiography is limited by a poor acoustic window, patients are often referred for MRI. Our hypothesis is that a cheaper and more widely available diagnostic modality like myocardial perfusion single photon emission computed tomography (SPECT) may be helpful in the diagnosis of ACM.

Objective

The purpose of this prospective study was to define the characteristics of rest and stress SPECT studies in patients with known ACM, and whether SPECT may be helpful in the diagnosis of ACM.

Methods

Adult patients with ACM were enrolled in the study. Diagnosis was made with 2-D echo. A rest and exercise or dipyridamole stress SPECT study was performed in all patients with Tc-99m sestamibi.

Results

We enrolled 20 patients (mean age 60 ± 16 years), 9 were female, with ACM. SPECT at rest revealed in 15 patients (75%) an increased apical tracer uptake, a spade-like deformity of the left ventricular chamber, and the “Solar Polar” map pattern consistent with ACM. The sensitivity, specificity, positive predictive value, and negative predictive value of SPECT for detecting ACM were 75%, 100%, 100%, and 80%, respectively.

Conclusion

Three-fourths of adult patients with ACM showed, on myocardial perfusion SPECT, characteristic findings which were not seen in age-matched control subjects, such as a significant increased apical tracer uptake, a spade-like deformity of the left ventricle, and the “Solar Polar” map. Nuclear physicians should be aware of these SPECT findings because many ACM patients may first end up in the nuclear labs due to their markedly abnormal ECG for exclusion of obstructive coronary artery disease.

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References

  1. 1.

    Koga Y, Itaya K, Toshima H. Prognosis in hypertrophic cardiomyopathy. Am Heart J 1984;108:351-9.

  2. 2.

    Sakamoto T, Tei C, Murayama M, et al. Giant T-wave inversion as a manifestation of asymmetrical apical hypertrophy (AAH) of the left ventricle: Echocardiographic and ultrasono-cardiotomographic study. Jpn Heart J 1976;17:611-29.

  3. 3.

    Sayin T, Kocum T, Kervancioglu C. Apical hypertrophic cardiomyopathy mimics acute coronary syndrome. Int J Cardiol 2001;80:77-9.

  4. 4.

    Ward RP, Weinert L, Spencer KT, et al. Quantitative diagnosis of apical cardiomyopathy using contrast echocardiography. J Am Soc Echocardiogr 2002;15:316-22.

  5. 5.

    Reddy V, Korcarz C, Weinert L, et al. Apical hypertrophic cardiomyopathy. Circulation 1998;98:2354.

  6. 6.

    Ward RP, Pokharna HK, Lang RM, Williams KA. Resting “Solar Polar” map pattern and reduced apical flow reserve: Characteristics of apical hypertrophic cardiomyopathy on SPECT myocardial perfusion imaging. J Nucl Cardiol 2003;10:506-12.

  7. 7.

    Chu WW, Wallhaus TR, Bianco JA. SPECT imaging of apical hypertrophic cardiomyopathy. Clin Nucl Med 2002;27:785-7.

  8. 8.

    Webb JG, Sasson Z, Rakowski H, Liu P, Wigle ED. Apical hypertrophic cardiomyopathy: Clinical follow-up and diagnostic correlates. J Am Coll Cardiol 1990;15:83-90.

  9. 9.

    Masoli O, Redruello M, Maciel N, Gagliardi J, Traverso S, Grynberg L, et al. Reproducibility of reversible myocardial perfusion defects by cold pressor test myocardial perfusion SPECT imaging. Circulation 2008;118:e162, p 1221.

  10. 10.

    Eriksson MJ, Sonnenberg B, Woo A, et al. Long-term outcome in patients with apical hypertrophic cardiomyopathy. J Am Coll Cardiol 2002;39:638-45.

  11. 11.

    Soman P, Swinburn J, Callister M, Stephens NG, Senior R. Apical hypertrophic cardiomyopathy: Bedside diagnosis by intravenous contrast echocardiography. J Am Soc Echocardiogr 2001;14:311-3.

  12. 12.

    Suzuki J, Shimamoto R, Nishikawa J, Yamazaki T, Tsuji T, Nakamura F, et al. Morphological onset and early diagnosis in apical hypertrophic cardiomyopathy: A long term analysis with nuclear magnetic resonance imaging. J Am Coll Cardiol 1999;33:146-51. Erratum in: J Am Coll Cardiol 1999;33(6):1750.

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Acknowledgment

We thank Ariel Desseno (General Electric) for technical assistance.

Author information

Correspondence to Tomás F. Cianciulli MD, FACC.

Additional information

T. F. Cianciulli, M. C. Saccheri, and O. H. Masoli are researchers of the Secretary of Health, Government of the City of Buenos Aires.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Two-dimensional echocardiogram, apical 4-chamber view revealing isolated apical hypertrophy of a patient with apical hypertrophic cardiomyopathy (WMV 365 kb)

Movie 1

Two-dimensional echocardiogram, apical 4-chamber view revealing isolated apical hypertrophy of a patient with apical hypertrophic cardiomyopathy (WMV 365 kb)

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Cianciulli, T.F., Saccheri, M.C., Masoli, O.H. et al. Myocardial perfusion SPECT in the diagnosis of apical hypertrophic cardiomyopathy. J. Nucl. Cardiol. 16, 391–395 (2009). https://doi.org/10.1007/s12350-008-9045-x

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Keywords

  • Single photon emission computed tomography
  • apical hypercaptation
  • apical hypertrophic cardiomyopathy
  • myocardial perfusion imaging