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“Apical thinning”: Relations between myocardial wall thickness and apical left ventricular tracer uptake as assessed with positron emission tomography myocardial perfusion imaging

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

A reduction in left ventricular apical tracer uptake (apical thinning) is frequently observed in myocardial perfusion imaging (MPI), yet its cause remains a matter of debate, particularly in perfusion emission tomography (PET). This analysis sought to determine whether apical thinning in PET-MPI is attributable to true anatomical thinning of the left ventricular apical myocardium.

Methods and Results

We retrospectively analyzed 57 patients without any history or signs of apical myocardial infarction who underwent rest PET-MPI with 13N-ammonia and contrast-enhanced cardiac computed tomography (CT). Semi-quantitative normalized percent apical 13N-ammonia uptake at rest, myocardial blood flow (MBF), and k2 wash-out rate constants were compared to apical myocardial wall thickness measurements derived from CT and base-to-apex gradients were calculated. Apical thinning was found in 93% of patients and in 74% when analysis of normalized apical tracer uptake was confined to end-systole. No significant correlation was found between apical myocardial thickness and apical tracer uptake (r = − 0.080, P = .553), MBF (r = − 0.211, P = .115), or k2 wash-out rate (r = − 0.023, P = .872), nor between apical myocardial thickness and any gradients. A statistically significant but small difference in apical myocardial thickness was observed in patients with moderately to severely reduced apical tracer uptake vs patients with normal to mildly reduced uptake (4.3 ± 0.7 mm vs 4.7 ± 0.7 mm; P = .043).

Conclusions

Apical thinning is a highly prevalent finding during 13N-ammonia PET-MPI that is not solely attributable to true anatomical apical wall thickness or the partial volume effect. Other factors that yet need to be identified seem to have a more prominent impact.

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Abbreviations

AC:

Attenuation correction

CABG:

Coronary artery bypass grafting

CT:

Computed tomography

ED/ES:

End-diastole/end-systole

MBF:

Myocardial blood flow

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

RS:

Rest perfusion score of segment 17

SPECT:

Single photon emission computed tomography

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Disclosure

The authors do not have any personal conflicts of interest to declare. However, the University Hospital Zurich holds a research contract with GE Healthcare.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland

    Dominik A. Steffen MBChB, Andreas A. Giannopoulos MD, PhD, Marvin Grossmann MD, Michael Messerli MD, Moritz Schwyzer MD, Christoph Gräni MD, Cathérine Gebhard MD, Aju P. Pazhenkottil MD, Philipp A. Kaufmann MD & Ronny R. Buechel MD

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  1. Dominik A. Steffen MBChB
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  2. Andreas A. Giannopoulos MD, PhD
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Correspondence to Ronny R. Buechel MD.

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Steffen, D.A., Giannopoulos, A.A., Grossmann, M. et al. “Apical thinning”: Relations between myocardial wall thickness and apical left ventricular tracer uptake as assessed with positron emission tomography myocardial perfusion imaging. J. Nucl. Cardiol. 27, 452–460 (2020). https://doi.org/10.1007/s12350-018-1397-2

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