Clinical InvestigationCongestive Heart FailureLate gadolinium enhancement on cardiac magnetic resonance and phenotypic expression in hypertrophic cardiomyopathy
Section snippets
Study patients
From January 2005 to August 2009, 124 HCM patients (53 ± 17 years, 86 men) from 2 centers (Ospedale Mauriziano, Torino, Italy, and Ospedale Cardinal Massaia, Asti, Italy) were prospectively evaluated with CMR.
All patients underwent a complete cardiac evaluation, which included detailed history and clinical examination, 12-lead electrocardiogram, echocardiography, treadmill exercise test (Bruce protocol), and 24-hour electrocardiogram Holter monitoring within 3 months before the CMR study.
Definitions
Patient characteristics
Patient characteristics and distributions of risk factors are listed in Table I. At CMR, study patients were 53 ± 17 years of age; 86 (69%) were male. Of the 124 patients, 36 (29%) had a family history of sudden death, 11 (9%) had at least an episode of unexplained syncope, 9 (7%) had extreme LV hypertrophy, 8 (6%) had abnormal exercise blood pressure response, and 20 (16%) had nonsustained ventricular tachycardia episodes on Holter monitoring. One hundred five patients (85%) had 0 to 1 risk
Discussion
Hypertrophic cardiomyopathy is characterized by the presence of extensive myocardial disarray and various patterns of myocardial fibrosis. Cardiac magnetic resonance is the imaging tool of choice for 3-dimensional assessment of ventricular mass, chamber volume, cardiac function, and pattern and distribution of hypertrophy.10 Cardiac magnetic resonance with LGE represents a unique way to identify areas of fibrosis in different areas of the left ventricle.11, 12 Moreover, the presence of LGE
Conclusions
We found an independent association, even at multivariate analysis, between the entity of LGE and maximum LV wall thickness, mass, and perfusion alterations in patients with HCM. Our data support the potential role of myocardial fibrosis as detected by CMR in the arrhythmogenesis. Whether large areas of LGE translate into clinical events later on awaits further long-term follow-up studies.
Acknowledgements
Marzia Casetta, MD, and Maria Cristina Rosa Brusin, MD (Ospedale degli Infermi, Rivoli, Torino, Italy).
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Left ventricular remodeling and fibrosis: Sex differences and relationship with diastolic function in hypertrophic cardiomyopathy
2015, European Journal of RadiologyCitation Excerpt :The presence of LGE is considered to be traditional risk factors for progression of LV remodeling [21]. Previous studies showed that the extent of LGE correlated with LV mass and end-diastolic volume in patients with HCM [22,23]. Rudolph et al. observed LGE in approximately 70% of HCM patients.
Magnetic resonance imaging of hypertrophic cardiomyopathy: Beyond left ventricular wall thickness
2015, Canadian Association of Radiologists JournalCitation Excerpt :This modality has better soft tissue resolution and better contrast between blood and myocardium. It allows a much more accurate characterization of heart volumes and functions, tissue morphology, and distribution of myocardial hypertrophy [1,16]. It also makes it possible to exclude other disease entities that could perhaps mimic HCM with other imaging modalities [2,13,17].
Sex-dependent pathophysiological mechanisms in hypertrophic cardiomyopathy: Implications for rhythm disorders
2015, Heart RhythmCitation Excerpt :The exacerbated LV remodeling in male patients might be caused by increased fibrosis, as replacement fibrosis is thought to be a potentiating element of LV remodeling in HCM.45 Indeed, fibrosis, assessed either at necropsy46 or noninvasively with late gadolinium enhancement magnetic resonance imaging,47 is present at a higher level in male patients. In addition to the contractile deficits seen in patients with HCM, the structural and physiological changes in the myocardium make patients with HCM more susceptible to rhythm disorders.
Predicting the future in hypertrophic cardiomyopathy: From histopathology to flow to function
2012, Journal of the American Society of EchocardiographyDiffuse myocardial fibrosis in hypertrophic cardiomyopathy can be identified by cardiovascular magnetic resonance, and is associated with left ventricular diastolic dysfunction
2012, Journal of Cardiovascular Magnetic Resonance