CARDIOVASCULAR MRI IN THE EVALUATION OF HYPERTROPHIC CARDIOMYOPATHY

Abstrakt

BACKGROUND: Hypertrophic Cardiomyopathy (HCM) is the most common genetic cardiovascular disorder and is the 1st cause of sudden cardiac death (SCD) among young patients. Trans Thoracic Echocardiography (TTE) is the usual screening modality however, some limitations impede complete evaluation. Cardiac magnetic resonance (CMR) imaging is a multi-parametric imaging modality allowing a comprehensive patient and disease-tailored evaluation of HCM.
AIM: To describe morphologic MR features, including late gadolinium enhancement (LGE), in patients of HCM and to compare MRI features and functional measurements with those obtained at TTE and to correlate MRI findings with clinical features.
STUDY DESIGN: Prospective and retrospective observational study.
PARTICIPANTS: Patients suspected or known case of HCM.
METHODS: The patients with HCM were selected according to the inclusion and exclusion criteria. Clinical presentation and any family history of HCM/SCD were noted. All the patients were assigned a particular HCM morphology. Quantitative measurements including LV wall thickness, LVOT obstruction gradient, LVEF, LA diameter, LA area and LV mass index were obtained on TTE & CMR and the results were compared. Additional parameters on CMR were also obtained.
RESULTS AND CONCLUSION: Asymmetrical septal hypertrophy was the most common variant of HCM in our study present in 69% of patients. Increased ventricular wall thickness was accurately diagnosed in all patients on CMR in comparison to TTE which missed the diagnosis in 3(5.2%) patients and underestimated the thickness in patients with thickness > 30 mm. The mean LVEF in our study on CMR was 65.3±10% as compared to 61.08±8.6% TTE (p-value <0.0001). The mean ventricular mass in our study cohort was 237.1 ± 75.1 g (range 119- 525.9g). At the time of presentation, more than half of the patients in our study group had LGE(n=33; 56.9%).The most common pattern was patchy mid myocardial enhancement in septum predominantly at the site of insertion of RV wall into septum which was present in 72.8% of patients.
IMPLICATIONS: CMR is the best imaging modality for overall assessment of patients with HCM and to stratify patients for the risk of developing SCD.