Document Detail


Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography.
MedLine Citation:
PMID:  3499997     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Myocardial ischemia may play a critical role in the symptomatic presentation and natural history of hypertrophic cardiomyopathy (HCM). To assess the relative prevalence and functional significance of myocardial perfusion abnormalities in patients comprising the broad clinical spectrum of HCM, we studied 72 patients (ages 12 to 69 years, mean 40) using thallium-201 emission computed tomography. Imaging was performed immediately after maximal exercise and again after a 3 hr delay. Regional perfusion defects were identified in 41 of the 72 patients (57%). Fixed or only partially reversible defects were evident in 17 patients, 14 of whom (82%) had left ventricular ejection fractions of less than 50% at rest. Twenty-four patients demonstrated perfusion defects during exercise that completely reversed at rest; all had normal or hyperdynamic left ventricular systolic function (ejection fraction greater than or equal to 50%). Perfusion abnormalities were present in all regions of the left ventricle. However, the fixed defects were observed predominantly in segments of the left ventricular wall that were of normal or only mildly increased (15 to 20 mm) thickness; in contrast, a substantial proportion (41%) of the completely reversible defects occurred in areas of moderate-to-marked wall thickness (greater than or equal to 20 mm, p less than .001). Neither a history of chest pain nor its provocation with treadmill exercise was predictive of an abnormal thallium study, since regional perfusion defects were present in 10 of 18 (56%) completely asymptomatic patients, compared with 31 of 54 (58%) symptomatic patients. These data indicate that myocardial perfusion abnormalities occur commonly among patients with HCM. Fixed or only partially reversible defects suggestive of myocardial scar and/or severe ischemia occur primarily in patients with impaired systolic performance. Completely reversible perfusion abnormalities occur predominantly in patients with normal or supranormal left ventricular systolic function. Such dynamic changes in regional thallium activity may reflect an ischemic process that contributes importantly to the clinical manifestations and natural history of HCM.
Authors:
P T O'Gara; R O Bonow; B J Maron; B A Damske; A Van Lingen; S L Bacharach; S M Larson; S E Epstein
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  76     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1987 Dec 
Date Detail:
Created Date:  1987-12-28     Completed Date:  1987-12-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1214-23     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD 20892.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cardiomyopathy, Hypertrophic / physiopathology*
Child
Coronary Disease / diagnosis*,  radionuclide imaging
Echocardiography
Electrocardiography
Exercise Test
Female
Heart Ventricles / radionuclide imaging
Humans
Male
Middle Aged
Thallium Radioisotopes / diagnostic use
Tomography, Emission-Computed*
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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