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Clinical implications of abnormal septal uptake of 123I-BMIPP in patients with hypertrophic cardiomyopathy
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Abstracts Wednesday morning, April 26, 1995
P19-413
P19-415
EXERCISE THALLIUM-201 SCINTIGRAPHY IN HYPERTROPHIC CARDIOMYOPATHY J Candsll, J Pslet. J Castell*, S Aguadd*. P Blanch. B Romero. E Galve, A Garcia-Burillo*. J Soler Soler. Servicio de Cardio|og[a. Servicio de Mediclna Nuclear*. Hospital General Universitari Vail d'Hebron. Barcelona.
Comparison between fatty acid metabolism and myocardial perfusion in patients with hypertrophic cardiomyopathy.
Some studies nave suggested that the finding of ischasmia in exercme perfusion scintigraphy could be predictive of unfavourable outcome in hypertrophic cardiornyopathy. To assess such hypothesis; 73 consecutive patlents with hypertrophic cardiomyopathy were investigated. }n all of them echo-DooDler study and perfueion scintigtaphy had been performecl. Hotter monitoring, radionuclide ventriculography and cardiac catheterization w=th coronary angl0graphy were performed n 60, 47 and 18 patients, respectively. The mean follow-uo time from the diagnosis was 6 years {'~-24~ Results: 4 2 % of patients had perfusion defects [anteroeeotal in 15. apical in 10 and inferoposterior in 22). There was no significant difference in clinical parameters and the remaining studies between patientes with and without perfus{on defects. 201TI + ( n = 3 1 ) 201TI- (n=42) V. ~sot: EF V I < 5 0 11 (35 % ) 18 (43 %) Holter: Vent. Tach 3 (10 %) 3 ( 7 %) VPC/24h>5OO 6 (19 %) 3 ( 7 %) A-V Block 1 ( 3 %) 1 ( 2 %) Echo-Doppler: Obstruction 14 (45 %) 2 0 (48 %) Clinical Parameters: Dispnea 21 (68 %) 31 (74 %) Angtna 8 (25 %) 7 (17 %) Syncope 3 (10 %) 2 ( 5 %) Card. failure 3 ( 1 0 %) 6 (14 %) Infarction ' 2 ( 6 %) 1 ( 2 %) Death 3 (10 %) 1 ( 2 %) Coronary Angio: 10 ( 2 4 %) Normal 5 (16 %) Abnorma 2 (6%) 1 ( 2 %) Conclusions: In patients with hypertrophic cardiomyopathy, there are no differences in clinical data and data from other studies between those with scintigraphy perfusion defects and those without.
W E D N E S D A Y P M A P R I L
JOURNAL OF NUCLEAR CARDIOLOGY March/April 1995, Part 2
Y Ohtake, A Moriguchi, I Adachi, I Narabayashi, M Suwa, Y Hirota, K Kawamura. Osaka Medical College, Japan. Both TI-201 exercise loading myocardial scintigraphy and 1-123 BMIPP myocardial scintigraphy were performed in 28 patients with hypertrophic cardiomyopathy(HCM) including I obstructive type, 15 asymmetrical hypertrophic type, 10 al~ical hypertrophic type and 2 dilated stage The radioactivity in the five segments (anterior, septaL apical, posterior and lateral) was assessed qualitatively. The results from both T1-201 exercise loading myocardial images(EX and RE) and 1-123 BMIPP myocardial images (BM) are scored according to the following scales: 0, perfusion defect; 1, notable defects~ 2, clear but modest defects; 3, normal; 4, hypertrophic uptake. BM showed modest defects in all cases without perfusion defects at both EX and RE. BM showed large and notable defects in 5 cases, in spite of perfusion defects at EX only in 6 cases. In 17 cases of perfusion defect at both EX and RE, BM had larger defects than that of EX or RE in 11 cases. Totally defect size of BM is larger than that of EX(17/23, 74%) and RE (11/17, 65%). And BM shows modest defects or notable defects with or without the evidence of myocardial perfusion defects in EX or RE (28/28, 100%), independently of the type of HCM. These data suggests that (1) there is a slight or marked decline in the fatty acid metabolism in all patients with HCM, (2) decreased fatty acid metabolism takes precedence over the myocardial ischemia.
P19-414
P19-416
CLINICAL IMPLICATIONS OF ABNORMAL SEPTAL UPTAKE OF 123I_ BMI PP IN PATIENTS WITH HYPERTROPHIC CARDI OMYOPATHY
Pseudo-normalization of Diastolic Function Detected in Ventricular Volume Curve is the Significant Predictor of
Ta tsuya Kamada, Motoi Morota, Me gumi Matsumoto, Ichiro Harada, T a k e s h i Watanabe, Y a s u h i k o Kobayashi, Y o s i k a z u Nagai, C h i h a r u Ibukiyama. Tokyo Medical College, Tokyo, JAPAN .
H Kobayashi,R Asano, K lmamura, Y Ikkatai, K Kusakabe S Hosoda, Tokyo Women's Medical College. Tokyo, Japan
Reduced patients
septal uptake of I~3I-BMIpP in with hypertrophic cardi omy opa %by HCM) was investigated in relation to is 9hemia. z23I-BMi PP scint igr aphy, exercise 2~ sc int igr aphy, echoc a r d i o g r a p h y and c o r o n a r y a r t e r i o g r a p h y (CAG) were p e r f o r m e d on 14 HCM patients presenting with asymmetric Septa i hyper trophy (ASH) . De f ect BMIPP scores (D S) Were calculated from images, r e v e r s i b l e d e f e c t scores (KS) from TI images and s q u e e z i n g scores (sqs) from CAG. The p a t i e n t s Were d i v i d e d into two groups, group N w i t h o u t low septal u p t a k e 'of BMIPP and group P w i t h low septal uptake, and RS, septal wall t h i c k n e s s a n d SqS were compared between them. Abnormal septal u p t a k e of B M I P P was n o t e d in 9 patients. Re, septal wall t h i c k n e s s a n d SqS were all significantly higher in group P than in group N. There w a s a p o s i t i v e c o r r e l a t i o n b e t w e e n DS on the one h a n d a n d KS a n d SqS on the other. The r e s u l t s of this study suggest that m y o c a r d i a l ischemia is a s s o c i a t e d w i t h abnormal septal u p t a k e of B M I P P
Poor Prognosis in Patients with Dilated Cardiomyopathy
To assess the prognostic value of pseudonormalization of diastolic function in patients with dilated cardiomyopathy (DCM), left ventricular volume curves of radionuc de ventriculography were analyzed i n 5 3 DCM patients with LVEF<30%. All cases were studied radionucl de ventriculo-graphy in medically controlled Condition. 1/3 I ng fraction (I/3FF) were evaluated in left ventricular volume curve, and patients were divided into 2 gi,oups accord ng to the 1/3FF results; Group A: i/3FF>35%, psedo-normalization of left ventricular diastolic function (N=23), Group B: 1/3FF<35%, decreased left ventricular diastolic function (N=30). Survival curve
was analyzed using Kaplan,Meier method. Prognostic value of 1/3FF was compared with other prognostic indices: X-ray cardi0-thoraCic ratio NYHA grade, LVEF, echocardi0graphic M mode data. Mean survival duration n group A (1.8=~-0.6 years) was significantly shorter than that in group B (5.0-*0.7 years). One year and 2 year survival rate in group A were 42% and 25%, respectively: Degree of mitral valve regurgitation was not correlated with I/3FF. I/3FF was the most valuable prognostic predictor in these prognostic ~indiCes. Conclusion: Pseudo-normalization of diastolic function detected in ventricular volume curve is the significant predictor of poor prognosis in patients with DCM.
Abstracts Wednesday morning, April 26, 1995
P19-413
P19-415
EXERCISE THALLIUM-201 SCINTIGRAPHY IN HYPERTROPHIC CARDIOMYOPATHY J Candsll, J Pslet. J Castell*, S Aguadd*. P Blanch. B Romero. E Galve, A Garcia-Burillo*. J Soler Soler. Servicio de Cardio|og[a. Servicio de Mediclna Nuclear*. Hospital General Universitari Vail d'Hebron. Barcelona.
Comparison between fatty acid metabolism and myocardial perfusion in patients with hypertrophic cardiomyopathy.
Some studies nave suggested that the finding of ischasmia in exercme perfusion scintigraphy could be predictive of unfavourable outcome in hypertrophic cardiornyopathy. To assess such hypothesis; 73 consecutive patlents with hypertrophic cardiomyopathy were investigated. }n all of them echo-DooDler study and perfueion scintigtaphy had been performecl. Hotter monitoring, radionuclide ventriculography and cardiac catheterization w=th coronary angl0graphy were performed n 60, 47 and 18 patients, respectively. The mean follow-uo time from the diagnosis was 6 years {'~-24~ Results: 4 2 % of patients had perfusion defects [anteroeeotal in 15. apical in 10 and inferoposterior in 22). There was no significant difference in clinical parameters and the remaining studies between patientes with and without perfus{on defects. 201TI + ( n = 3 1 ) 201TI- (n=42) V. ~sot: EF V I < 5 0 11 (35 % ) 18 (43 %) Holter: Vent. Tach 3 (10 %) 3 ( 7 %) VPC/24h>5OO 6 (19 %) 3 ( 7 %) A-V Block 1 ( 3 %) 1 ( 2 %) Echo-Doppler: Obstruction 14 (45 %) 2 0 (48 %) Clinical Parameters: Dispnea 21 (68 %) 31 (74 %) Angtna 8 (25 %) 7 (17 %) Syncope 3 (10 %) 2 ( 5 %) Card. failure 3 ( 1 0 %) 6 (14 %) Infarction ' 2 ( 6 %) 1 ( 2 %) Death 3 (10 %) 1 ( 2 %) Coronary Angio: 10 ( 2 4 %) Normal 5 (16 %) Abnorma 2 (6%) 1 ( 2 %) Conclusions: In patients with hypertrophic cardiomyopathy, there are no differences in clinical data and data from other studies between those with scintigraphy perfusion defects and those without.
W E D N E S D A Y P M A P R I L
JOURNAL OF NUCLEAR CARDIOLOGY March/April 1995, Part 2
Y Ohtake, A Moriguchi, I Adachi, I Narabayashi, M Suwa, Y Hirota, K Kawamura. Osaka Medical College, Japan. Both TI-201 exercise loading myocardial scintigraphy and 1-123 BMIPP myocardial scintigraphy were performed in 28 patients with hypertrophic cardiomyopathy(HCM) including I obstructive type, 15 asymmetrical hypertrophic type, 10 al~ical hypertrophic type and 2 dilated stage The radioactivity in the five segments (anterior, septaL apical, posterior and lateral) was assessed qualitatively. The results from both T1-201 exercise loading myocardial images(EX and RE) and 1-123 BMIPP myocardial images (BM) are scored according to the following scales: 0, perfusion defect; 1, notable defects~ 2, clear but modest defects; 3, normal; 4, hypertrophic uptake. BM showed modest defects in all cases without perfusion defects at both EX and RE. BM showed large and notable defects in 5 cases, in spite of perfusion defects at EX only in 6 cases. In 17 cases of perfusion defect at both EX and RE, BM had larger defects than that of EX or RE in 11 cases. Totally defect size of BM is larger than that of EX(17/23, 74%) and RE (11/17, 65%). And BM shows modest defects or notable defects with or without the evidence of myocardial perfusion defects in EX or RE (28/28, 100%), independently of the type of HCM. These data suggests that (1) there is a slight or marked decline in the fatty acid metabolism in all patients with HCM, (2) decreased fatty acid metabolism takes precedence over the myocardial ischemia.
P19-414
P19-416
CLINICAL IMPLICATIONS OF ABNORMAL SEPTAL UPTAKE OF 123I_ BMI PP IN PATIENTS WITH HYPERTROPHIC CARDI OMYOPATHY
Pseudo-normalization of Diastolic Function Detected in Ventricular Volume Curve is the Significant Predictor of
Ta tsuya Kamada, Motoi Morota, Me gumi Matsumoto, Ichiro Harada, T a k e s h i Watanabe, Y a s u h i k o Kobayashi, Y o s i k a z u Nagai, C h i h a r u Ibukiyama. Tokyo Medical College, Tokyo, JAPAN .
H Kobayashi,R Asano, K lmamura, Y Ikkatai, K Kusakabe S Hosoda, Tokyo Women's Medical College. Tokyo, Japan
Reduced patients
septal uptake of I~3I-BMIpP in with hypertrophic cardi omy opa %by HCM) was investigated in relation to is 9hemia. z23I-BMi PP scint igr aphy, exercise 2~ sc int igr aphy, echoc a r d i o g r a p h y and c o r o n a r y a r t e r i o g r a p h y (CAG) were p e r f o r m e d on 14 HCM patients presenting with asymmetric Septa i hyper trophy (ASH) . De f ect BMIPP scores (D S) Were calculated from images, r e v e r s i b l e d e f e c t scores (KS) from TI images and s q u e e z i n g scores (sqs) from CAG. The p a t i e n t s Were d i v i d e d into two groups, group N w i t h o u t low septal u p t a k e 'of BMIPP and group P w i t h low septal uptake, and RS, septal wall t h i c k n e s s a n d SqS were compared between them. Abnormal septal u p t a k e of B M I P P was n o t e d in 9 patients. Re, septal wall t h i c k n e s s a n d SqS were all significantly higher in group P than in group N. There w a s a p o s i t i v e c o r r e l a t i o n b e t w e e n DS on the one h a n d a n d KS a n d SqS on the other. The r e s u l t s of this study suggest that m y o c a r d i a l ischemia is a s s o c i a t e d w i t h abnormal septal u p t a k e of B M I P P
Poor Prognosis in Patients with Dilated Cardiomyopathy
To assess the prognostic value of pseudonormalization of diastolic function in patients with dilated cardiomyopathy (DCM), left ventricular volume curves of radionuc de ventriculography were analyzed i n 5 3 DCM patients with LVEF<30%. All cases were studied radionucl de ventriculo-graphy in medically controlled Condition. 1/3 I ng fraction (I/3FF) were evaluated in left ventricular volume curve, and patients were divided into 2 gi,oups accord ng to the 1/3FF results; Group A: i/3FF>35%, psedo-normalization of left ventricular diastolic function (N=23), Group B: 1/3FF<35%, decreased left ventricular diastolic function (N=30). Survival curve
was analyzed using Kaplan,Meier method. Prognostic value of 1/3FF was compared with other prognostic indices: X-ray cardi0-thoraCic ratio NYHA grade, LVEF, echocardi0graphic M mode data. Mean survival duration n group A (1.8=~-0.6 years) was significantly shorter than that in group B (5.0-*0.7 years). One year and 2 year survival rate in group A were 42% and 25%, respectively: Degree of mitral valve regurgitation was not correlated with I/3FF. I/3FF was the most valuable prognostic predictor in these prognostic ~indiCes. Conclusion: Pseudo-normalization of diastolic function detected in ventricular volume curve is the significant predictor of poor prognosis in patients with DCM.