1
|
Yin L, Xu HY, Zheng SS, Zhu Y, Xiao JX, Zhou W, Yu SS, Gong LG. 3.0 T magnetic resonance myocardial perfusion imaging for semi-quantitative evaluation of coronary microvascular dysfunction in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2017; 33:1949-1959. [DOI: 10.1007/s10554-017-1189-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/09/2017] [Indexed: 01/21/2023]
|
2
|
Morgan RB, Kwong RY. CMR in Phenotyping the Arrhythmic Substrate. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
3
|
Chiribiri A, Leuzzi S, Conte MR, Bongioanni S, Bratis K, Olivotti L, De Rosa C, Lardone E, Di Donna P, Villa ADM, Cesarani F, Nagel E, Gaita F, Bonamini R. Rest perfusion abnormalities in hypertrophic cardiomyopathy: correlation with myocardial fibrosis and risk factors for sudden cardiac death. Clin Radiol 2015; 70:495-501. [PMID: 25659937 PMCID: PMC4398331 DOI: 10.1016/j.crad.2014.12.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/16/2014] [Accepted: 12/29/2014] [Indexed: 01/27/2023]
Abstract
Aim To measure the prevalence of abnormal rest perfusion in a population of consecutive patients with known hypertrophic cardiomyopathy (HCM) referred for cardiovascular MRI (CMR), and to assess any associations between abnormal rest perfusion and the presence, pattern, and severity of myocardial scar and the presence of risk factors for sudden death. Materials and methods Eighty consecutive patients with known HCM referred for CMR underwent functional imaging, rest first-pass perfusion, and late gadolinium enhancement (LGE). Results Thirty percent of the patients had abnormal rest perfusion, all of them corresponding to areas of mid-myocardial LGE and to a higher degree of segmental hypertrophy. Rest perfusion abnormalities correlated with more extensive and confluent LGE. The subgroup of patients with myocardial fibrosis and rest perfusion abnormalities (fibrosis+/perfusion+) had more than twice the incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring in comparison to patients with myocardial fibrosis and normal rest perfusion (fibrosis+/perfusion–) and patients with no fibrosis and normal rest perfusion (fibrosis–/perfusion–). Conclusions First-pass perfusion CMR identifies abnormal rest perfusion in a significant proportion of patients with HCM. These abnormalities are associated with the presence and distribution of myocardial scar and the degree of hypertrophy. Rest perfusion abnormalities identify patients with increased incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring, independently from the presence of myocardial fibrosis. 30% of patients with HCM have perfusion abnormalities related to scar. No rest perfusion abnormalities were observed in areas of viable myocardium. Scar-related perfusion abnormalities were associated with the incidence of NSVT.
Collapse
Affiliation(s)
- A Chiribiri
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK; Department of Internal Medicine, University of Torino, Italy.
| | - S Leuzzi
- Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy
| | - M R Conte
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - S Bongioanni
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - K Bratis
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK
| | - L Olivotti
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK; Department of Cardiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - C De Rosa
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - E Lardone
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - P Di Donna
- Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy
| | - A D M Villa
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK
| | - F Cesarani
- Department of Radiology, Cardinal Massaia Hospital, Asti, Italy
| | - E Nagel
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK
| | - F Gaita
- Department of Internal Medicine, University of Torino, Italy; Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy
| | - R Bonamini
- Department of Internal Medicine, University of Torino, Italy
| |
Collapse
|
4
|
Chen X, Zhao T, Lu M, Yin G, Xiangli W, Jiang S, Prasad S, Zhao S. The relationship between electrocardiographic changes and CMR features in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2014; 30 Suppl 1:55-63. [PMID: 24723003 DOI: 10.1007/s10554-014-0416-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/01/2014] [Indexed: 01/01/2023]
Abstract
To investigate the relationship between electrocardiographic (ECG) abnormalities and left ventricular (LV) segmental hypertrophy and myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy (HCM). 118 asymptomatic or mildly symptomatic patients with HCM were examined with late gadolinium enhancement (LGE) CMR, 12-lead ECG, and echocardiography. The distribution and magnitude of LV segmental hypertrophy and LGE were assessed and analyzed in relation to ECG abnormalities. Abnormal electrocardiograms were found in 113 of 118 (95%) patients. Negative T waves were associated with greater apical septal thickness (P = 0.009) and an increased ratio of LV septum to free wall thickness (P = 0.01). Giant negative T waves (GNT) were found in 19 patients (16%), and were associated with apical HCM (P < 0.001), greater apical thickness (P = 0.004), and increased ratio of LV apical to basal wall thickness (P < 0.001). However, no significant association was demonstrated between GNT and apical LGE (P = 0.71). Abnormal Q waves were associated with greater basal anteroseptal thickness (P = 0.001), maximal basal thickness (P = 0.004), and more segments with extensive LGE (>75% wall thickness involved) (P = 0.001). LV hypertrophy was related to greater LV mass (P = 0.002) and LV end diastolic volume (P = 0.002). In addition, a modest but significant correlation was observed between maximum LV wall thickness and the Romhilt-Estes score (r = 0.41, P < 0.001). GNT were associated with apical HCM and an increased ratio of LV apical to basal wall thickness. Abnormal Q waves were related to basal anteroseptal hypertrophy and segmental extensive LGE.
Collapse
Affiliation(s)
- Xiuyu Chen
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xi Cheng District, Beijing, 100037, China
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is clinically defined as unexplained myocardial hypertrophy, and it is an autosomal dominant disease of the cardiac sarcomere. It is present in 1 in 500 in the general adult population, making it the most common genetic cardiovascular disease. The pathophysiology of HCM is complex, leading to significant variability in clinical presentation. This, combined with the lack of randomized trials, makes the management of these patients difficult. FINDINGS The majority of patients with HCM are asymptomatic without a substantial reduction in survival. However, a considerable portion of patients will experience significant symptoms and HCM-related death, and effective therapies are available for these patients. Patients may have symptoms of heart failure from outflow tract obstruction and/or restrictive physiology. Medical therapy targeted at the underlying pathophysiology should be used, and surgical myectomy or alcohol septal ablation is available for those with refractory symptoms. While the overall risk of sudden cardiac death (SCD) is low in HCM patients, some are at elevated risk for and experience SCD, a devastating outcome in young patients. Risk stratification for SCD and treatment with implantable cardioverter-defibrillators is paramount. Many HCM patients will also develop atrial fibrillation, and this is often poorly tolerated. A rhythm control strategy with antiarrhythmic drugs or catheter ablation is often necessary, and anticoagulation should be administered to reduce the risk of thromboembolism. Finally, family members of patients with HCM should be regularly screened with electrocardiography and echocardiography. CONCLUSIONS HCM is a complex disease with heterogeneous phenotypes and clinical manifestations. The management of HCM focuses on reducing symptoms of heart failure, preventing SCD, treating atrial fibrillation, and screening family members. Treatment should be tailored to the unique characteristics of each individual patient.
Collapse
Affiliation(s)
- Alan D Enriquez
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Martin E Goldman
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
6
|
Lu M, Zhao S, Yin G, Jiang S, Zhao T, Chen X, Tian L, Zhang Y, Wei Y, Liu Q, He Z, Xue H, An J, Shah S. T1 mapping for detection of left ventricular myocardial fibrosis in hypertrophic cardiomyopathy: a preliminary study. Eur J Radiol 2013; 82:e225-31. [PMID: 23333530 DOI: 10.1016/j.ejrad.2012.12.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/18/2012] [Accepted: 12/21/2012] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the diagnostic value of T1 mapping imaging of evaluating fibrosis in patients with hypertrophic cardiomyopathy (HCM). MATERIALS AND METHODS 21 subjects with HCM and 18 healthy volunteers underwent conventional late gadolinium enhancement (LGE) imaging and T1 mapping imaging. The region of myocardium in HCM is divided into remote area of LGE, peri-LGE, LGE (halo-like LGE and typical patchy LGE). These regions combined with normal volunteers' myocardium were calculated by the reduced percent of T1 value (RPTV). RESULTS The RPTV in healthy volunteers was no significant comparing with that in the remote area of LGE in HCM subjects (3.98 ± 3.19 vs. 3.34 ± 2.75, P>0.05). There were significant statistical differences in pairwise among the remote area of LGE, peri-LGE, halo-like LGE and typical patchy LGE in the RPTV (P<0.0001). ROC curves indicated that the T1 mapping imaging has a greater area under the curve comparing with that of traditional LGE imaging (0.975 ± 0.07 vs. 0.753 ± 0.26, P<0.0001). CONCLUSIONS HCM has a high prevalence of fibrosis and with varying severity. T1 mapping imaging can be a useful method to evaluate the severity of the fibrosis in HCM.
Collapse
Affiliation(s)
- Minjie Lu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|