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Journal of Nuclear Cardiology

, Volume 23, Issue 6, pp 1304–1314 | Cite as

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

  • Paco E. BravoEmail author
  • Abdel Tahari
  • Iraklis Pozios
  • Hong-Chang Luo
  • Frank M. Bengel
  • Richard L. Wahl
  • M. Roselle Abraham
  • Theodore P. Abraham
Original Article

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.

Keywords

PET TID apparent LV cavity dilatation HCM myocardial ischemia 

Abbreviations

HCM

Hypertrophic cardiomyopathy

LVCD

Left ventricular cavity dilatation

MBF

Myocardial blood flow

CFR

Coronary flow reserve

TID

Transient ischemic dilatation

PM

Papillary muscles

Notes

Disclosure

The authors declare that they have no conflict of interest.

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Copyright information

© American Society of Nuclear Cardiology 2015

Authors and Affiliations

  • Paco E. Bravo
    • 1
    • 3
    Email author
  • Abdel Tahari
    • 1
  • Iraklis Pozios
    • 2
  • Hong-Chang Luo
    • 2
  • Frank M. Bengel
    • 4
  • Richard L. Wahl
    • 1
  • M. Roselle Abraham
    • 2
  • Theodore P. Abraham
    • 2
  1. 1.Department of RadiologyJohns Hopkins UniversityBaltimoreUSA
  2. 2.Division of CardiologyJohns Hopkins UniversityBaltimoreUSA
  3. 3.Division of CardiologyUniversity of WashingtonSeattleUSA
  4. 4.Department of Nuclear MedicineHannover Medical SchoolHannoverGermany

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