Elsevier

American Heart Journal

Volume 151, Issue 2, February 2006, Pages 426-435
American Heart Journal

Clinical Investigation
Imaging and Diagnostic Testing
Prognostic utility of single-photon emission computed tomography in adult patients with hypertrophic cardiomyopathy

https://doi.org/10.1016/j.ahj.2005.02.050Get rights and content

Background

Data derived from stress myocardial perfusion imaging (MPI) carry prognostic significance in young patients with hypertrophic cardiomyopathy (HCM), but there are limited data on the utility of stress MPI in patients with HCM who are older. This study examined the prognostic significance of stress MPI in an adult population of patients with HCM.

Methods

We examined 158 patients with HCM (aged 60 ± 16 years, 61% men) who underwent exercise or pharmacologic stress MPI. Summed stress score (SSS, normal = 56) and summed reversibility scores were calculated for each patient. Follow-up was complete in 157 (99%) patients at a median duration of 5.2 years.

Results

Normal single-photon emission computed tomography (SPECT) images were present in 38% of the population. Summed stress score (P = .01) and summed reversibility score (P = .03) were both significantly associated with cardiovascular death. Survival at 10 years was significantly better in those with normal versus abnormal SPECT (89% vs 67%, P = .04). Ten-year survival also was better in those without versus those with ischemia (90% vs 64%, P = .02). Five-year survival could be stratified by SSS risk categories: low risk (SSS ≥53), 97%; intermediate risk (SSS = 48-52), 94%; and high risk (SSS ≤47), 79% (P = .04). Bivariate models of SSS and other significant covariates supported an independent relation of SSS to cardiovascular death.

Conclusions

In an older population of patients with HCM referred for SPECT imaging, abnormal stress MPI identifies those at increased risk of cardiovascular death.

Section snippets

Study population

The Mayo Foundation Institutional Review Board approved this study. The study population consisted of 180 consecutive patients with HCM who underwent MPI at the Mayo Clinic (Rochester, MN) between January 1986 and September 2000. Patients <18 years (n = 7) were excluded. Other exclusion criteria were resting scan only (n = 3), history of either percutaneous coronary intervention (PCI) (n = 6) or coronary artery bypass graft (CABG) (n = 4), and refusal of research authorization (n = 2), leaving

Baseline characteristics

Mean age was 60 ± 16 years (range 18-88 years). Most (61%) patients were men and had Canadian Cardiovascular Society (CCS) class III/IV angina (53%). History of myocardial infarction and history of diabetes mellitus were present in 8% and 10% of the patients, respectively. Mean maximal wall thickness was 19 ± 5 mm. A significant LVOT gradient (≥30 mm Hg gradient at rest or ≥50 mm Hg with provocation) was present in 37 (23%) patients. Other characteristics are listed in Table I. The reasons for

Discussion

Because of inherent abnormalities in the myocardial substrate, patients with HCM are prone to ischemia. Single-photon emission computed tomography MPI is a noninvasive measure of myocardial ischemia with established prognostic capabilities in patients with coronary atherosclerosis. Myocardial perfusion imaging has been examined in pediatric patients with HCM, but data on its ability to risk stratify adult patients with HCM are limited.

The current investigation examined the prognostic

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