Circulation, Vol 76, 1214-1223, Copyright © 1987 by American Heart Association
PT O'Gara, RO Bonow, BJ Maron, BA Damske, A Van Lingen, SL Bacharach, SM Larson and SE Epstein
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.
ARTICLES
Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography
Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD 20892.
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