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Role of quantitative myocardial positron emission tomography for risk stratification in patients with hypertrophic cardiomyopathy: a 2016 reappraisal.
Castagnoli, Helga; Ferrantini, Cecilia; Coppini, Raffaele; Passeri, Alessandro; Baldini, Katia; Berti, Valentina; Cecchi, Franco; Olivotto, Iacopo; Sciagrà, Roberto.
Afiliación
  • Castagnoli H; Department of Experimental and Clinical Biomedical Sciences - Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy.
  • Ferrantini C; Referral Center for Myocardial Diseases and Genetic Diagnostics Unit, Careggi University Hospital, Florence, Italy.
  • Coppini R; Referral Center for Myocardial Diseases and Genetic Diagnostics Unit, Careggi University Hospital, Florence, Italy.
  • Passeri A; Department of Experimental and Clinical Biomedical Sciences - Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy.
  • Baldini K; Referral Center for Myocardial Diseases and Genetic Diagnostics Unit, Careggi University Hospital, Florence, Italy.
  • Berti V; Department of Experimental and Clinical Biomedical Sciences - Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy.
  • Cecchi F; Referral Center for Myocardial Diseases and Genetic Diagnostics Unit, Careggi University Hospital, Florence, Italy.
  • Olivotto I; Referral Center for Myocardial Diseases and Genetic Diagnostics Unit, Careggi University Hospital, Florence, Italy.
  • Sciagrà R; Department of Experimental and Clinical Biomedical Sciences - Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy. roberto.sciagra@unifi.it.
Eur J Nucl Med Mol Imaging ; 43(13): 2413-2422, 2016 Dec.
Article en En | MEDLINE | ID: mdl-27527796
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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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Cardiomiopatía Hipertrófica / Enfermedad de la Arteria Coronaria / Tomografía de Emisión de Positrones / Imagen de Perfusión Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Eur J Nucl Med Mol Imaging Asunto de la revista: MEDICINA NUCLEAR Año: 2016 Tipo del documento: Article País de afiliación: Italia
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Cardiomiopatía Hipertrófica / Enfermedad de la Arteria Coronaria / Tomografía de Emisión de Positrones / Imagen de Perfusión Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Eur J Nucl Med Mol Imaging Asunto de la revista: MEDICINA NUCLEAR Año: 2016 Tipo del documento: Article País de afiliación: Italia