Delayed-enhancement MRI of apical hypertrophic cardiomyopathy: assessment of the intramural distribution and comparison with clinical symptoms, ventricular arrhythmias, and cine MRI

Author:

Amano Yasuo1,Takayama Morimasa2,Fukushima Yoshimitsu1,Kitamura Mitsunobu3,Kumita Shinichiro1

Affiliation:

1. Department of Radiology, Nippon Medical School, Tokyo

2. Department of Cardiology, Sakakibara Heart Institute, Tokyo

3. Coronary Care Unit, Chiba-Hokuso Hospital of Nippon Medical School, Chiba, Japan

Abstract

Background Hypertrophic cardiomyopathy (HCM) is reported to show patchy midwall myocardial hyperenhancement on delayed-enhancement magnetic resonance imaging (DE-MRI). The intramural distribution of myocardial hyperenhancement and its correlation with clinical symptoms, ventricular arrhythmias, and cardiac function have not been described forsymptomatic apical HCM. Purpose To evaluate the features and significance of myocardial hyperenhancement on DE-MRI insymptomatic apical HCM. Material and Methods Thirteen patients with symptomatic apical HCM and their 65 apical segments were investigated. Myocardial hyperenhancement and regional and global functional parameters were determined with MRI. We investigated the intramural distribution and frequencies of this myocardial hyperenhancement and compared them with the patients' clinical symptoms, the presence of ventricular arrhythmias, and cine MRI. Results Eight (61.5%) patients with symptomatic apical HCM displayed apical myocardial hyperenhancement, and 22 (33.8%) of the 65 apical segments examined showed myocardial hyperenhancement. Of the myocardial hyperenhancement observed, 81.8% showed a subendocardial pattern.The hyperenhanced apical myocardium had a lower percentage of systolic myocardial thickening, and was associated with serious symptoms (e.g. syncope) and ventricular arrhythmias. Conclusion Patients with symptomatic apical HCMshowed myocardial hyperenhancement involving the subendocardial layer, which might be related to regional systolic dysfunction, serious clinical symptoms, and ventricular arrhythmias.

Publisher

SAGE Publications

Subject

Radiology Nuclear Medicine and imaging,General Medicine,Radiological and Ultrasound Technology

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