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Tran TV, Djaileb L, Riou L, Lantuejoul LR, Giai J, Barone-Rochette G. Coronary microvascular dysfunction as assessed by multimodal diagnostic imaging in patients with hypertrophic cardiomyopathy is related to the severity of cardiac dysfunction. Microcirculation 2024; 31:e12843. [PMID: 38174616 DOI: 10.1111/micc.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/05/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Coronary microvascular dysfunction (CMD) plays a major role in hypertrophic cardiomyopathy (HCM) physiopathology but its assessment in clinical practice remains a challenge. Nowadays, innovations in invasive and noninvasive coronary evaluation using multimodal imaging provide options for the diagnosis of CMD. The objective of the present study was to investigate if new multimodal imaging diagnosis of CMD could detect HCM patients with more impaired cardiac function by left atrioventricular coupling index (LACI). METHODS AND RESULTS A total of 32 consecutive patients with a confirmed diagnosis of HCM (62 ± 13 years, 62% men) were prospectively screened for CMD using a multimodal imaging method. LACI was assessed by cardiovascular magnetic resonance imaging. Fifteen (47%) patients had CMD by multimodal imaging method. Patients with CMD presented a significantly higher LACI (48.5 ± 25.4 vs. 32.5 ± 10.6, p = .03). A multivariate logistic regression analysis demonstrated that CMD was independently associated with LACI (OR = 1.069, 95% CI 1.00-1.135, p = .03). CONCLUSION Multimodal imaging diagnosis of CMD is applicable to HCM patients and is associated with more impaired cardiac function.
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Affiliation(s)
- Tien Vuong Tran
- Department of Cardiology, University Hospital, Grenoble, France
| | - Loic Djaileb
- Department of Nuclear Medicine, University Hospital, Grenoble, France
- Université Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, Grenoble, France
| | - Laurent Riou
- Université Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, Grenoble, France
| | | | - Joris Giai
- Université Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, TIMC UMR 5525, Grenoble, France
| | - Gilles Barone-Rochette
- Department of Cardiology, University Hospital, Grenoble, France
- Université Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, Grenoble, France
- FACT (French Alliance for Cardiovascular Clinical Trials), an F-CRIN network, Paris, France
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Djaïleb L, De Leiris N, Canu M, Sy OP, Seiller A, Leenhardt J, Charlon C, Faure M, Caillard J, Broisat A, Borel AL, Lablanche S, Betry C, Ghezzi C, Vanzetto G, Fagret D, Riou LM, Barone-Rochette G. Regional CZT myocardial perfusion reserve for the detection of territories with simultaneously impaired CFR and IMR in patients without obstructive coronary artery disease: a pilot study. J Nucl Cardiol 2023; 30:1656-1667. [PMID: 36813934 DOI: 10.1007/s12350-023-03206-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/06/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To assess the diagnostic performances of CZT myocardial perfusion reserve (MPR) for the detection of territories with simultaneous impaired coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients without obstructive coronary artery disease. METHODS Patients were prospectively included before being referred for coronary angiography. All patients underwent CZT MPR before invasive coronary angiography (ICA) and coronary physiology assessment. Rest and dipyridamole-induced stress myocardial blood flow (MBF) and MPR were quantified using 99mTc-SestaMIBI and a CZT camera. Fractional flow reserve (FFR), Thermodilution CFR, and IMR were assessed during ICA. RESULTS Between December 2016 and July 2019, 36 patients were included. 25/36 patients presented no obstructive coronary artery disease. A complete functional assessment was performed in 32 arteries. No territory presented a significant ischemia on CZT myocardial perfusion imaging. A moderate yet significant correlation was observed between regional CZT MPR and CFR (r = 0.4, P = .03). Sensitivity, specificity, positive and negative predictive value, and accuracy of regional CZT MPR versus the composite invasive criterion (impaired CFR and IMR) were 87 [47% to 99%], 92% [73% to 99%], 78% [47% to 93%], 96% [78% to 99%], and 91% [75% to 98%], respectively. All territories with a regional CZT MPR ≤ 1.8 showed a CFR < 2. Regional CZT MPR values were significantly higher in arteries with CFR ≥ 2 and IMR < 25 (negative composite criterion, n = 14) than in those with CFR < 2 and IMR ≥ 25 (2.6 [2.1 to 3.6] versus 1.6 [1.2 to 1.8]), P < .01). CONCLUSION Regional CZT MPR presented excellent diagnostic performances for the detection of territories with simultaneously impaired CFR and IMR reflecting a very high cardiovascular risk in patients without obstructive coronary artery disease.
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Affiliation(s)
- Loïc Djaïleb
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France.
| | - Nicolas De Leiris
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Marjorie Canu
- Cardiology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Olivier Phan Sy
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Alexandre Seiller
- Clinical Investigation Center-Technological Innovation, INSERM CIC1406, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Julien Leenhardt
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Clémence Charlon
- Cardiology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Marine Faure
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Jessica Caillard
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Alexis Broisat
- INSERM, LRB, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Anne-Laure Borel
- Endocrinology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Sandrine Lablanche
- Endocrinology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Cécile Betry
- Endocrinology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | | | - Gérald Vanzetto
- Cardiology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Daniel Fagret
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Laurent M Riou
- INSERM, LRB, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Gilles Barone-Rochette
- Cardiology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
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Azarine A, Scalbert F, Garçon P. Cardiac functional imaging. Presse Med 2022; 51:104119. [PMID: 35321846 DOI: 10.1016/j.lpm.2022.104119] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 01/01/2023] Open
Abstract
During the last 20 years, cardiac imaging has drastically evolved. Positron emission tomography (PET), fast three-dimensional (3D) imaging with the latest generations of echocardiography & multi-detector computed tomography (CT), stress perfusion assessed by magnetic resonance imaging (MRI), blood flow analysis using four-dimensional (4D) flow MRI, all these techniques offer new trends for optimal noninvasive functional cardiac imaging. Dynamic functional imaging is obtained by acquiring images of the heart at different phases of the cardiac cycle, allowing assessment of cardiac motion, function, and perfusion. Between CT and Cardiac MRI (CMR), CMR has the best temporal resolution, which is suitable for functional imaging while cardiac CT provides higher spatial resolution with isotropic data that have an identical resolution in the three dimensions of the space. The latest generations of CT scanners enable whole heart assessment in one beat, offering also an acceptable temporal resolution with the possibility to display the images in a dynamic mode. Another rapidly growing technique using functional and molecular imaging for the assessment of biological and metabolic pathways is the PET using radio-labeled tracers. Meanwhile, the oldest cardiac imaging tool with doppler ultrasound technology has never stopped evolving. Echocardiography today performs 3D imaging, stress perfusion, and myocardial strain assessment, with high temporal resolution. It still is the first line and more accessible exam for the patient. These different modalities are complementary and may be even combined into PET-CT or PET-MRI. The ability to combine the functional/molecular data with anatomical images may implement a new dimension to our diagnostic tools.
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Affiliation(s)
- Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France.
| | - François Scalbert
- Nuclear Medecine Department, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877, Paris, France
| | - Philippe Garçon
- Cardiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
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Prognostic value of SPECT myocardial perfusion entropy in high-risk type 2 diabetic patients. Eur J Nucl Med Mol Imaging 2020; 48:1813-1821. [PMID: 33219463 DOI: 10.1007/s00259-020-05110-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Risk stratification of patients with type 2 diabetes mellitus (T2D) remains suboptimal. We hypothesized that myocardial perfusion entropy (MPE) quantified from SPECT myocardial perfusion images may provide incremental prognostic value in T2D patients independently from myocardial ischemia. METHODS T2D patients with very high and high cardiovascular risk were prospectively included (n = 166, 65 ± 12 years). Stress perfusion defect was quantified by visual evaluation of SPECT MPI. SPECT MPI was also used for the quantification of rest and stress MPE. The primary end point was major adverse cardiac events (MACEs) defined as cardiac death, myocardial infarction (MI), and myocardial revascularization > 3 months after SPECT. RESULTS Forty-four MACEs were observed during a 4.6-year median follow-up. Significant differences in stress MPE were observed between patients with and without MACEs (4.19 ± 0.46 vs. 3.93 ± 0.40; P ≤ .01). By Kaplan-Meier analysis, the risk of MACEs was significantly higher in patients with higher stress MPE (log-rank P ≤ 01). Stress MPE and stress perfusion defect (SSS ≥ 4) were significantly associated with the risk of MACEs (hazard ratio 2.77 and 2.06, respectively, P < .05 for both) after adjustment for clinical and imaging risk predictors as identified from preliminary univariate analysis. MPE demonstrated incremental prognostic value over clinical risk factors, stress test EKG and SSS as evidenced by nested models showing improved Akaike information criterion (AIC), reclassification (global continuous net reclassification improvement [NRI]: 63), global integrated discrimination improvement (IDI: 6%), and discrimination (change in c-statistic: 0.66 vs 0.74). CONCLUSIONS Stress MPE provided independent and incremental prognostic information for the prediction of MACEs in diabetic patients. TRIAL REGISTRATION NUMBER NCT02316054 (12/12/2014).
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