Clinical InvestigationDelayed Enhancement on Cardiac Magnetic Resonance and Clinical, Morphological, and Electrocardiographical Features in Hypertrophic Cardiomyopathy
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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Cited by (18)
Low-intensity late gadolinium enhancement predominates in hypertrophic cardiomyopathy
2015, Clinical ImagingDistribution of late gadolinium enhancement in end-stage hypertrophic cardiomyopathy and dilated cardiomyopathy: Differential diagnosis and prediction of cardiac outcome
2014, Magnetic Resonance ImagingCitation Excerpt :McCrohon et al. reported the characteristic mid-wall LGE in patients with DCM, and LGE-CMR is useful to differentiate DCM from ICM [14,15]. We compared LGE distribution between patients with HCM and with DCM, and showed that LGE predominantly localized at the inter-ventricular septum, but varied among patients and different disease states; in a certain part of patients, LGE spread diffusely into whole LV segments [15,16]. The goal of present study was to characterize the prognostic implications of LGE distribution in patients with DCM by comparison with patients with ES-HCM in order to identify high-risk patients who are most likely to benefit from early aggressive therapies (e.g. intensified medical therapy and early device therapy) [17,18].
Relationship of ECG findings to phenotypic expression in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance study
2013, International Journal of CardiologyCitation Excerpt :This concept, however, is based on a limited number of studies mostly performed in the early echocardiographic era [13–17]. Recent advances in cardiac magnetic (CMR) imaging, by virtue of its high-resolution volumetric reconstruction of LV chamber, currently afford a highly accurate and reproducible quantitative assessment of LV chamber morphology and mass, a precise characterization of the pattern and the distribution of LV hypertrophy [18–24], and the possibility to identify myocardial fibrosis areas using gadolinium [25–31]. Therefore, we took advantages of these unique features of CMR to assess the relationship of the HCM phenotype with standard 12-lead ECG patterns, as observed in two referral centers with specific expertise in cardiomyopathies.
Scar mapping for risk stratification of sudden cardiac death: Where are we now?
2011, Cardiac Electrophysiology ClinicsCitation Excerpt :Recently, Yan and colleagues21 showed that a larger scar border zone on MRI, which may indicate tissue heterogeneity and arrhythmogenic substrate, is actually predictive of all-cause and cardiovascular mortality independent of age and systolic function. It bears emphasis that this intriguing link between myocardial scar area and morphology, as assessed by MRI, and adverse cardiovascular outcome is being increasingly recognized in different myocardial diseases, including chronic myocarditis22 and hypertrophic cardiomyopathy.23,24 The role of electroanatomic mapping (EAM) in the risk stratification of patients undergoing prophylactic ICD implant has not been established.
Conflict of interest: none