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higher incidence of vasodilator-induced left ventricular cavity dilation by pet when compared to treadmill exercise-echo in hypertrophic cardiomyopathy
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نویسنده
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lu dai-yin ,yalçin hulya ,sivalokanathan sanjay ,greenland gabriela v. ,vasquez nestor ,yalçin fatih ,zhao min ,valenta ines ,ganz peter ,pampaloni miguel hernandez ,zimmerman stefan ,schindler thomas h. ,abraham theodore p. ,abraham m. roselle
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منبع
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journal of nuclear cardiology - 2020 - دوره : 27 - شماره : 6 - صفحه:2031 -2043
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چکیده
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Vasodilator-induced transient left ventricular cavity dilation (lvcd) by positron emission tomography (pet) is associated with microvascular dysfunction in hypertrophic cardiomyopathy (hcm). here we assessed whether hcm patients who develop lvcd by pet during vasodilator stress also develop lv cavity dilation by echocardiography (echo-lvcd) following exercise stress. a retrospective analysis of cardiac function and myocardial blood flow (mbf) was conducted in 108 hcm patients who underwent perfusion-pet and exercise-echo as part of their clinical evaluation. we performed a head-to-head comparison of lv volumes and ejection fraction (lvef) at rest and stress (during vasodilator stress, post-exercise), in 108 hcm patients. a ratio > 1.13 of stress to rest lv volumes was used to define pet-lvcd, and a ratio > 1.17 of stress to rest lvesv was used to define echo-lvcd. patients were divided into 2 groups based on the presence/absence of pet-lvcd. mbf and myocardial flow reserve were quantified by pet, and global longitudinal strain (gls) was assessed by echo at rest/stress in the two groups. pet-lvcd was observed in 51% (n = 55) of hcm patients, but only one patient had evidence of echo-lvcd (ratio = 1.36)—this patient also had evidence of pet-lvcd (ratio = 1.20). the pet-lvcd group had lower pet-lvef during vasodilator stress, but echo-lvef increased in both groups post-exercise. the pet-lvcd group demonstrated higher lv mass, worse gls at rest/stress, and lower myocardial flow reserve. incidence of ischemic st-t changes was higher in the pet-lvcd group during vasodilator stress (42 vs 17%), but similar (30%) in the two groups during exercise. pet-lvcd reflects greater degree of myopathy and microvascular dysfunction in hcm. differences in the cardiac effects of exercise and vasodilators and timing of stress-image acquisition could underlie discordance in ischemic ekg changes and lvcd by echo and pet, in hcm.
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کلیدواژه
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hypertrophic cardiomyopathy ,left ventricular cavity dilation ,positron emission tomography ,strain ,echocardiography
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آدرس
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johns hopkins university, hypertrophic cardiomyopathy center of excellence, usa. taipei veterans general hospital, division of cardiology, taiwan. national yang-ming university, institute of public health, taiwan, johns hopkins university, hypertrophic cardiomyopathy center of excellence, usa, johns hopkins university, hypertrophic cardiomyopathy center of excellence, usa, johns hopkins university, hypertrophic cardiomyopathy center of excellence, usa. university of california san francisco, division of cardiology, usa, johns hopkins university, hypertrophic cardiomyopathy center of excellence, usa, johns hopkins university, hypertrophic cardiomyopathy center of excellence, usa, johns hopkins university, department of radiology and radiological sciences, usa, johns hopkins university, department of radiology and radiological sciences, usa, university of california san francisco, division of cardiology, usa, university of california san francisco, department of radiology and biomedical imaging, usa, johns hopkins university, department of radiology and radiological sciences, usa, johns hopkins university, department of radiology and radiological sciences, usa, johns hopkins university, hypertrophic cardiomyopathy center of excellence, usa. university of california san francisco, division of cardiology, usa, johns hopkins university, hypertrophic cardiomyopathy center of excellence, usa. university of california san francisco, division of cardiology, usa
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Authors
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