Myocardial ischemia on thallium scintigraphy in hypertrophic cardiomyopathy: predictor of sudden cardiac death.

Abstract

HomeCirculationVol. 104, No. 13Myocardial Ischemia on Thallium Scintigraphy in Hypertrophic Cardiomyopathy Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBMyocardial Ischemia on Thallium Scintigraphy in Hypertrophic CardiomyopathyPredictor of Sudden Cardiac Death John H. Haley, MD and Todd D. Miller, MD John H. HaleyJohn H. Haley From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn. Search for more papers by this author and Todd D. MillerTodd D. Miller From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn. Search for more papers by this author Originally published25 Sep 2001https://doi.org/10.1161/hc3801.096179Circulation. 2001;104:e71An 18-year-old man with known hypertrophic obstructive cardiomyopathy since age 9 was referred for evaluation. His mother had died suddenly at age 24, and her autopsy demonstrated hypertrophic obstructive cardiomyopathy. The patient was asymptomatic. His only medication was propranolol. Two-dimensional echocardiographic images demonstrated normal left ventricular size with hyperdynamic function (ejection fraction 80%) with a septal thickness of 30 mm (Figure, a). The Doppler-derived maximal instantaneous gradient was 21 mm Hg. Download figureDownload PowerPointEchocardiographic apical 4-chamber (A) and short-axis (B) views of the left ventricle (LV) demonstrating normal left ventricular size with marked septal hypertrophy. RV indicates right ventricle; RA, right atrium; LA, left atrium; S, septum; and L, lateral wall. C, Thallium scintigraphy showing stress and redistribution images in the horizontal long-axis (HLA) and short-axis (SA) views. Increased thallium uptake in the septum (arrow) is present on the redistribution (Redist) images in both views and in the anterior wall on the short-axis images.An exercise thallium study demonstrated markedly increased thickness of the ventricular septum and part of the anterior wall, with a large area of anterior wall and septal ischemia primarily involving the subendocardium (Figure, b).Inducible ischemia on thallium scintigraphy identifies a subgroup of young, asymptomatic patients with hypertrophic obstructive cardiomyopathy who are at increased risk of sudden cardiac death. In these patients, more aggressive therapy, including placement of an automatic implantable cardioverter defibrillator, may be warranted.FootnotesReprint requests to Todd D. Miller, MD, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Velasco-Sanchez D, Lambert R, Turpin S, Laforge S, Fournier A, Lapierre C and Dahdah N (2011) Right Ventricle Myocardial Perfusion Scintigraphy: Feasibility and Expected Values in Children, Pediatric Cardiology, 10.1007/s00246-011-0128-0, 33:2, (295-301), Online publication date: 1-Feb-2012. Maron M, Olivotto I, Maron B, Prasad S, Cecchi F, Udelson J and Camici P (2009) The Case for Myocardial Ischemia in Hypertrophic Cardiomyopathy, Journal of the American College of Cardiology, 10.1016/j.jacc.2009.04.072, 54:9, (866-875), Online publication date: 1-Aug-2009. Nagel E and Pettigrew R (2006) Myocardial Ischemia in Conditions Other Than Atheromatous Coronary Artery Disease Noninvasive Imaging of Myocardial Ischemia, 10.1007/1-84628-156-3_17, (277-286), . Olivotto I, Gistri R, Petrone P, Pedemonte E, Vargiu D and Cecchi F (2003) Maximum left ventricular thickness and risk of sudden death in patients with hypertrophic cardiomyopathy, Journal of the American College of Cardiology, 10.1016/S0735-1097(02)02713-4, 41:2, (315-321), Online publication date: 1-Jan-2003. Nakamura T, Sakamoto K, Yamano T, Kikkawa M, Zen K, Hikosaka T, Kubota T, Azuma A and Nishimura T (2002) Increased plasma brain natriuretic peptide level as a guide for silent myocardial ischemia in patients with non-obstructive hypertrophic cardiomyopathy, Journal of the American College of Cardiology, 10.1016/S0735-1097(02)01813-2, 39:10, (1657-1663), Online publication date: 1-May-2002. Liew A, Vassiliou V, Cooper R and Raphael C (2017) Hypertrophic Cardiomyopathy—Past, Present and Future, Journal of Clinical Medicine, 10.3390/jcm6120118, 6:12, (118) September 25, 2001Vol 104, Issue 13 Advertisement Article InformationMetrics https://doi.org/10.1161/hc3801.096179 Originally publishedSeptember 25, 2001 PDF download Advertisement