Resting "Solar Polar" map pattern and reduced apical flow reserve: characteristics of apical hypertrophic cardiomyopathy on SPECT myocardial perfusion imaging.
BACKGROUND
Patients with apical hypertrophic cardiomyopathy (ACM) are often referred for myocardial perfusion single photon emission computed tomography (SPECT) as a result of marked T-wave inversion and chest pain syndromes. Stress perfusion defects have been reported in ACM, but the characteristic SPECT pattern as well as the typical findings on volume-weighted polar maps has not been described.


RESULTS
Dual-isotope rest (thallium 201) and exercise or adenosine stress (technetium 99m tetrofosmin) myocardial perfusion SPECT was performed in 11 patients with ACM, including 8 with either normal coronary arteriography (n = 5) or a low pretest probability of coronary artery disease (CAD) (n = 3), and 14 control patients with concentric left ventricular hypertrophy. An 8-pixel-diameter circular region of interest was used to quantitatively compare apical and septal counts on CEqual volume-weighted polar maps. A characteristic "Solar Polar" map pattern resulting from the increased apical counts was present in each ACM patient at rest, with a mean apical-septal ratio of 1.39 +/- 0.17 (range, 1.23-1.62, P <.01 vs concentric left ventricular hypertrophy group). With stress, there was a significant decrease in the apical-septal ratio (0.96 +/- 0.18, P <.001 vs rest) in the ACM subgroup without CAD.


CONCLUSIONS
Patients with ACM demonstrate a newly described "Solar Polar" map pattern at rest, as well as relative apical ischemia on the stress images even in the absence of CAD.
Ward
R Parker
RP
Department of Medicine, University of Chicago, Chicago, IL 60637, USA. pward@medicine.bsd.uchicago.edu
Pokharna
Hemlata K
HK
Lang
Roberto M
RM
Williams
Kim A
KA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002312:Cardiomyopathy, Hypertrophic / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012146:Rest; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013793:Thallium; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000145:classification / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C027549:thallium chloride; C078700:technetium tc-99m tetrofosmin; D013793:Thallium