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Role of quantitative myocardial positron emission tomography for risk stratification in patients with hypertrophic cardiomyopathy: a 2016 reappraisal

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Aims

Myocardial blood flow <1.1 mL/min/g following dipyridamole (Dip-MBF) assessed by positron emission tomography (PET) was identified in 2003 as an important outcome predictor in hypertrophic cardiomyopathy (HCM), based on scans performed in the 90s. However, such extreme Dip-MBF impairment is rarely observed in contemporary cohorts. We, therefore, reassessed the Dip-MBF threshold defining high-risk HCM patients.

Methods

Dip-MBF was measured using 13N-ammonia in 100 HCM consecutive patients, prospectively enrolled and followed for 4.0 ± 2.2 years. Outcome was assessed based on tertiles of Dip-MBF. The study end-point was a combination of cardiovascular death, progression to severe functional limitation, cardioembolic stroke, life-threatening ventricular arrhythmias.

Results

Global Dip-MBF was 1.95 ± 0.85, ranging from 0.7 to 5.9 mL/min/g. Dip-MBF tertile cut-off values were: 0.73 to 1.53 mL/min/g (lowest), 1.54 to 2.13 mL/min/g (middle), and 2.14 to 5.89 mL/min/g (highest). During follow-up, lowest tertile Dip-MBF was associated with sevenfold independent risk of unfavorable outcome compared to the other two tertiles. Dip-MBF 1.35 mL/min/g was identified as the best threshold for outcome prediction. Regional perfusion analysis showed that all cardiac deaths (n = 4) occurred in patients in the lowest tertile of lateral wall Dip-MBF (≤1.72 mL/min/g); septal Dip-MBF was not predictive.

Conclusions

Dip-MBF confirms its role as potent predictor of outcome in HCM. However, the threshold for prediction in a contemporary cohort is higher than that reported in earlier studies. Dip-MBF impairment in the lateral wall, possibly reflecting diffuse disease extending to non-hypertrophic regions, is a sensitive predictor of mortality in HCM.

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Authors and Affiliations

  1. Department of Experimental and Clinical Biomedical Sciences - Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy

    Helga Castagnoli, Alessandro Passeri, Valentina Berti & Roberto Sciagrà

  2. Referral Center for Myocardial Diseases and Genetic Diagnostics Unit, Careggi University Hospital, Florence, Italy

    Cecilia Ferrantini, Raffaele Coppini, Katia Baldini, Franco Cecchi & Iacopo Olivotto

Authors
  1. Helga Castagnoli
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  2. Cecilia Ferrantini
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  3. Raffaele Coppini
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  4. Alessandro Passeri
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  5. Katia Baldini
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  6. Valentina Berti
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  7. Franco Cecchi
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  8. Iacopo Olivotto
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  9. Roberto Sciagrà
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Corresponding author

Correspondence to Roberto Sciagrà.

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Funding sources

This work was supported by the Italian Ministry of Health “Hypertrophic cardiomyopathy: new insights from deep sequencing and psychosocial evaluation” (RF 2010 – 2313451), “Left ventricular hypertrophy in aortic valve disease and hypertrophic cardiomyopathy: genetic basis, biophysical correlates, and viral therapy models” (RF-2013-02356787), and “Mechanisms and treatment of coronary microvascular dysfunction in patients with genetic or secondary left ventricular hypertrophy”. NET-2011-02347173.

Conflicts of Interest

None declared.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Castagnoli, H., Ferrantini, C., Coppini, R. et al. Role of quantitative myocardial positron emission tomography for risk stratification in patients with hypertrophic cardiomyopathy: a 2016 reappraisal. Eur J Nucl Med Mol Imaging 43, 2413–2422 (2016). https://doi.org/10.1007/s00259-016-3465-7

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