Coronary microvascular disease in hypertrophic and infiltrative cardiomyopathies

Figures

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  Figure 1. CMD in a 66 years old patient with apical HCM. Left upper Panel shows 13N-ammonia PET perfusion study (short axis, horizontal and vertical long axis slices) with evidence of subendocardial perfusion defect in stress which did not correspond to a coronary artery supply territory as assessed in fused coronary computed tomography angiography and 13N-ammonia PET images (right upper panel). Lower panel shows quantitative PET analysis with evidence of CMD depicted by globally pathological MFR (Total MFR 1.93). The apical segments show markedly reduced hyperemic MBF and MFR while the microcirculature is also compromised on the non-hypertrophic inferior and septal LV-segments

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  Figure 2. Severe CMD in AFD cardiomyopathy. Upper panel shows electrocardiogram (ECG) (left) and two-dimensional TTE (right), ECG: the 12-lead ECG shows sinus bradycardia, short PR interval and left ventricular hypertrophy (LVH) with deep T wave inversion in the anterolateral leads. Echocardiogram: from the apical 4 chamber view severe concentric LVH is evident with maximal wall thickness of 26 mm at the septum (red line). Right ventricular hypertrophy is also present. Mid panel shows 13N-ammonia PET images, displayed in short axis, and vertical axis, and horizontal long axis. No significant perfusion defects are noted at rest. However, during pharmacological stress, severe global subendocardial ischemia is seen. Lower panel shows the quantitative PET analysis with severely reduced global and regional MFR (normal values >2.5). Reproduced with permission from Ref. 44

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  Figure 3. ATTR Amyloidosis and CMD. A 82-year-old patient with left ventricular hypertrophy on TTE was assessed for presence of cardiac amyloidosis. Upper left panel depicts planar whole-body scintigraphy with a bone tracer (Tc-99m-DPD) revealing increased myocardial tracer uptake consistent with cardiac ATTR amyloidosis. Upper right panel shows 13N-ammonia PET perfusion images (short axis, horizontal and vertical long axis slices) demonstrating no regional perfusion defect in stress or rest. Quantitative PET analysis shows a significant reduction of hyperemic MBF and a severely reduced global MFR (lower panels)