Masoud Shariat MD, Presenter: Nothing to Disclose

Paaladinesh Thavendiranathan MD, Abstract Co-Author: Nothing to Disclose

Elsie Nguyen MD, Abstract Co-Author: Nothing to Disclose

Bernd J. Wintersperger MD, Abstract Co-Author: Speakers Bureau, Bayer AG Speakers Bureau, Siemens AG

Narinder S. Paul MD, Abstract Co-Author: Research funded, Toshiba Corporation

Harry Rakowski, Abstract Co-Author: Nothing to Disclose

Andrew Michael Dominic Crean MD, Abstract Co-Author: Nothing to Disclose

Assess the utility of CTCA in the assessment of patients with HCM and anginal symptoms and compare the incidence of epicardial CAD to an age and gender matched control group.

Consecutive patients with HCM referred for CTCA over a 3 year period due to anginal symptoms (chest pain or shortness of breath) were identified retrospectively. Age and gender matched patients without HCM referred for CTCA over a 6 months period due to similar symptoms were used as controls. Data on CAD risk factors was collected in both groups. All patients had CTCA using an Aquilion One 320 scanner. The coronary arteries were evaluated independently by 2 blinded observers and any luminal narrowing scored quantitatively as follows: > 70% = severe; 50-70% = moderate; < 50% = mild; and none. For the HCM group, results of SPECT or CMR perfusion studies as well as catheter angiograms were recorded where available.

Total of 91 patients with HCM and 91 controls were included. No significance difference in cardiac risk factors was present between two groups. The CTCA was of diagnostic quality in all patients. The median (inter-quartile range) calcium score was lower in patients with HCM (0 [0-50] Hu versus 2[0-189] Hu) but did not reach statistical significance (p=0.23). The incidence of moderate to severe CAD was significantly lower in patients with HCM than in controls (6.6% versus 33.0%, p<0.001). The incidence of LAD disease was also significantly lower in the HCM patients (7.0% vs 20.9%, p=0.002). There was a higher incidence of myocardial bridging in patients with HCM (40.7% versus 6.6%, p<0.001), with longer and deeper bridged segments. Amongst a subgroup of HCM patients (n=24) who had either stress perfusion CMR or cardiac SPECT studies performed, 15/24 had false positive perfusion abnormalities for epicardial CAD.

We demonstrate the use of CTCA for assessment of anginal symptoms in patients with HCM. The incidence of moderate to severe CAD was significantly lower in our HCM patients compared to our control group. Given the high incidence of false positive findings on perfusion stress studies we propose that CTCA may be a useful gatekeeper to coronary angiography in the HCM patient with anginal symptoms.

We suggest that CTCA should be considered as a first-line investigation for HCM patients presenting with angina or anginal-equivalent symptoms.

Shariat, M, Thavendiranathan, P, Nguyen, E, Wintersperger, B, Paul, N, Rakowski, H, Crean, A, Utility of Computed Tomography Coronary Angiography in Patients with Hypertrophic Cardiomyopathy Presenting with Chest Pain or Angina-equivalent Symptoms.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011119.html