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²⁰¹Tl SPECT Abnormalities, Documented at Rest in Dilated Cardiomyopathy, Are Related to a Lower Than Normal Myocardial Thickness but Not to an Excess in Myocardial Wall Stress

¹ Department of Nuclear Medicine, Unité Propre de Recherche de l’Enseignement Superieur—Equipe d’Accueil 3447, Centre Hospitalier Universitaire, Nancy, France
² Department of Cardiology, Unité Propre de Recherche de l’Enseignement Superieur—Equipe d’Accueil 3447, Centre Hospitalier Universitaire, Nancy, France
³ Laboratory of Hematology, Faculty of Medicine, Université Henri Poincaré, Nancy, France

This study was aimed at determining whether the ²⁰¹Tl SPECT abnormalities documented in patients with dilated cardiomyopathy are related to a local excess in wall stress, which might act against the diastolic perfusion of myocardium. Methods: We included 6 healthy volunteers and 7 patients with idiopathic dilated cardiomyopathy who underwent ²⁰¹Tl SPECT at rest. On a 13-segment division of the left ventricle, indices of wall stress and tension were calculated at end-diastole by applying Laplace’s law, with thickness and curvature radii being determined for each segment on 2 orthogonal MRI slices. Results: Among all patients, 21 analyzed segments had ²⁰¹Tl SPECT defects (D+) and 67 had none (D-). Myocardial thickness was lower in D+ (0.88 ± 0.30 cm) than in D- (1.23 ± 0.33 cm, P = 0.0002) or in segments from healthy volunteers (0.99 ± 0.15 cm, P = 0.04). The index of end-diastolic wall tension was also lower in D+ (2.5 ± 1.0 N · m^-1 · mm Hg^-1) than in D- (3.3 ± 1.1 N · m^-1 · mm Hg^-1, P = 0.02) or in segments from healthy volunteers (3.2 ± 1.2 N · m^-1 · mm Hg^-1, P = 0.04). Last, the index of end-diastolic wall stress, determined by the ratio of wall tension index to myocardial thickness, was equivalent in D+, in D-, and in segments from healthy volunteers (respectively, 3.0 ± 1.4, 2.8 ± 1.2, and 3.2 ± 1.6 hN · m^-2 · mm Hg^-1). Conclusion: In patients with dilated cardiomyopathy, the abnormalities documented by ²⁰¹Tl SPECT at rest are related to a lower than normal wall thickness and not to an excess in wall stress or tension. Therefore, partial-volume effects are likely to induce these abnormalities, and they may be unrelated to any insufficiency of myocardial perfusion.

Key Words: ²⁰¹Tl • idiopathic dilated cardiomyopathy • SPECT • MRI • myocardial wall stress

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