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Myocardial metabolism, perfusion and risk assessment in non-obstructive hypertrophic cardiomyopathy using PET-CT
Session:
Sessão de Comunicações Orais 11 – Corações espessos e rígidos: amiloidose cardíaca e companhia
Speaker:
Mariana Isabel Cavaco Salvador
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.3 Myocardial Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Salvador; Patrícia Marques-Alves; Maria João Ferreira; Rodolfo Silva; Andreia Gomes; Antero Abrunhosa; Miguel Castelo-Branco; Wael Jaber; Lino Gonçalves
Abstract
<p style="text-align:justify"><strong>Background:</strong> Hypertrophic Cardiomyopathy (HCM) is a genetic disease carrying risks of heart failure and sudden cardiac death (SCD). While HCM involves multiple pathological processes, including myocardial inflammation and fibrosis, the utility of molecular imaging with Positron Emission Tomography-Computed Tomography (PET-CT) in this context remains unexplored. This study investigated the relationship<br /> between myocardial metabolism and perfusion in patients with non-obstructive HCM (NOHCM) using PET-CT.</p> <p style="text-align:justify"><strong>Methods and Results:</strong> We used PET-CT with [13N]NH3 (perfusion) and 2-[18F]FDG (perfusion) (metabolism/inflammation) to assess 30 NOHCM patients. Increased [13N]NH3 and 2-[18F]FDG uptake (Target to Background Ratio, TBR≥1.1) was detected in 53% of patients (average TBR 1.4 ± 0.5). The extent of this inflammatory pattern (mean 11.8 ± 17.2%) correlated significantly with maximal myocardial wall<br /> thickness (MMWT) (rho=0.49, p=0.009), left atrial volume (LAV) (rho=0.39, p=0.04) and NT-proBNP levels (rho=0.63, p=0.003). Maximum TBR correlated strongly with MMWT (rho=0.53, p=00.4), NT-proBNP (rho=0.70, p=0.001) and the SCD risk score (rho=0.38, p=0.04). A fibrotic (scar) pattern, encompassing 10.3 ± 10.2% of the left ventricle (LV), also correlated with the SCD risk score (rho=0.38, p=0.04).<br /> <strong>Conclusion:</strong> In NOHCM patients, PET-CT imaging provides unique and valuable insights into myocardial inflammation and fibrosis. These imaging markers are closely associated with established indicators of disease severity, including hypertrophy, left ventricular dysfunction, and the risk of sudden cardiac death.</p>
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