Higher incidence of vasodilator-induced left ventricular cavity dilation by PET when compared to treadmill exercise-ECHO in hypertrophic cardiomyopathy

Dai Yin Lu, Hulya Yalçin, Sanjay Sivalokanathan, Gabriela V. Greenland, Nestor Vasquez, Fatih Yalçin, Min Zhao, Ines Valenta, Peter Ganz, Miguel Hernandez Pampaloni, Stefan Zimmerman, Thomas H. Schindler, Theodore P. Abraham, M. Roselle Abraham

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
JournalJournal of Nuclear Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

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Hypertrophic Cardiomyopathy
Vasodilator Agents
Positron-Emission Tomography
Dilatation
Exercise
Incidence
Muscular Diseases
Echocardiography

Keywords

  • echocardiography
  • Hypertrophic cardiomyopathy
  • left ventricular cavity dilation
  • positron emission tomography
  • strain

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Higher incidence of vasodilator-induced left ventricular cavity dilation by PET when compared to treadmill exercise-ECHO in hypertrophic cardiomyopathy. / 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.

In: Journal of Nuclear Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Lu, DY, Yalçin, H, Sivalokanathan, S, Greenland, GV, Vasquez, N, Yalçin, F, Zhao, M, Valenta, I, Ganz, P, Pampaloni, MH, Zimmerman, S, Schindler, TH, Abraham, TP & Abraham, MR 2018, 'Higher incidence of vasodilator-induced left ventricular cavity dilation by PET when compared to treadmill exercise-ECHO in hypertrophic cardiomyopathy', Journal of Nuclear Cardiology. https://doi.org/10.1007/s12350-018-01521-x
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. / Higher incidence of vasodilator-induced left ventricular cavity dilation by PET when compared to treadmill exercise-ECHO in hypertrophic cardiomyopathy. In: Journal of Nuclear Cardiology. 2018.
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title = "Higher incidence of vasodilator-induced left ventricular cavity dilation by PET when compared to treadmill exercise-ECHO in hypertrophic cardiomyopathy",
abstract = "Background: 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. Methods: 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. Results: 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. Conclusion: 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.",
keywords = "echocardiography, Hypertrophic cardiomyopathy, left ventricular cavity dilation, positron emission tomography, strain",
author = "Lu, {Dai Yin} and Hulya Yal{\cc}in and Sanjay Sivalokanathan and Greenland, {Gabriela V.} and Nestor Vasquez and Fatih Yal{\cc}in and Min Zhao and Ines Valenta and Peter Ganz and Pampaloni, {Miguel Hernandez} and Stefan Zimmerman and Schindler, {Thomas H.} and Abraham, {Theodore P.} and Abraham, {M. Roselle}",
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T1 - Higher incidence of vasodilator-induced left ventricular cavity dilation by PET when compared to treadmill exercise-ECHO in hypertrophic cardiomyopathy

AU - Lu, Dai Yin

AU - Yalçin, Hulya

AU - Sivalokanathan, Sanjay

AU - Greenland, Gabriela V.

AU - Vasquez, Nestor

AU - Yalçin, Fatih

AU - Zhao, Min

AU - Valenta, Ines

AU - Ganz, Peter

AU - Pampaloni, Miguel Hernandez

AU - Zimmerman, Stefan

AU - Schindler, Thomas H.

AU - Abraham, Theodore P.

AU - Abraham, M. Roselle

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

AB - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

KW - echocardiography

KW - Hypertrophic cardiomyopathy

KW - left ventricular cavity dilation

KW - positron emission tomography

KW - strain

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