Clinical Investigation
Delayed Enhancement on Cardiac Magnetic Resonance and Clinical, Morphological, and Electrocardiographical Features in Hypertrophic Cardiomyopathy

https://doi.org/10.1016/j.cardfail.2008.11.014Get rights and content

Abstract

Background

The clinical, morphological, and electrocardiographical relevance of delayed enhancement (DE) in cardiac magnetic resonance (CMR) was studied in patients with hypertrophic cardiomyopathy (HCM).

Methods and Results

A total of 56 patients underwent both gadolinium-enhanced CMR and 12-lead electrocardiogram. The CMR demonstrated DE at the left ventricular (LV) wall in 39 patients. The patients with DE included more cases with dilated phase of HCM, higher New York Heart Association (NYHA) classes and incidence of ventricular tachyarrhythmias (VT), lower LV ejection fraction (LVEF) and mean LV wall thickness (WT), and a larger ratio of maximum to minimum LVWT. The QRS duration was prolonged and the QRS axis deviated toward left with increases in the DE volume (r = 0.58 and r = 0.41, P < .01). Abnormal Q waves were present in 5 patients and the location coincided with the DE segments in 4 patients, but the concordance was not significant. The amplitude of T waves correlated with the ratio of the apex to basal LVWT (r = 0.38, P < .01) and was more negative in cases with DE at the apex.

Conclusions

In HCM, the DE was associated with higher NYHA classes and prevalence of VT, impaired global LV function and asymmetrical hypertrophy, and conduction disturbance, abnormal Q waves, and giant negative T waves.

Section snippets

Patients

A total of 56 consecutive patients of HCM who underwent CMR between May 2003 and November 2007 were studied. HCM was diagnosed according to the World Health Organization/International Society and Federation of Cardiology definition of cardiomyopathies.18 The diagnosis of HCM was based on echocardiographic documentation of a hypertrophied nondilated LV in the absence of other cardiac systemic diseases that could produce the magnitude of hypertrophy evident at some time during the natural course

Patient Characteristics

The DE-CMR demonstrated focal or diffuse types of DE at the LV wall in 39 of the 56 patients (70%), but in none of the 11 normal controls. Table 1 demonstrates that the patients with DE included more D-HCM and higher New York Heart Association (NYHA) functional classes than those without DE. The incidence of VT in the 24-hour ambulatory Holter ECG was higher in the patients with DE and certain cases were treated with amiodarone or implantable cardioverter-defibrillator. Only 1 patient in each

Discussion

Using the cine-mode and DE-mode of CMR, this study clearly showed that the DE in HCM was correlated with higher NYHA functional classes and prevalence of VT in clinical features, impaired global LV function and asymmetrical hypertrophy in morphological features, and conduction disturbance, giant negative T waves, and possibly abnormal Q waves in the ECG features.

Conclusions

Risk stratification in HCM is difficult because of the heterogeneity in the clinical and phenotypic expression and the low event rate.22, 32, 33 This study showed the presence of DE to be associated with LV dysfunction and potentially fatal arrhythmias. It was also clarified that the DE was correlated with asymmetrical hypertrophy in the morphological features and conduction disturbance, giant negative T waves, and possibly abnormal Q waves in ECG features. However, this study was a

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    Conflict of interest: none

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