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Left ventricular hypertrophy successfully characterized with CV magnetic resonance
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Portions of the anterior free wall and contiguous anterior ventricular septum as assessed by CV magnetic resonance were most often the regions experiencing left ventricular hypertrophy in the setting of hypertrophic cardiomyopathy, researchers reported in new study results.
The researchers for the two-center study enrolled 333 consecutive patients with hypertrophic cardiomyopathy and attempted to characterize the pattern and distribution of LV hypertrophy. Patients were assessed using cine and late gadolinium enhancement CV MRI. The hypertrophy was focal in 41 patients, intermediate in 112 patients and diffuse in 180 patients.
According to the results, the basal anterior LV free wall and the contiguous anterior ventricular septum were the most commonly hypertrophied segments (n=256; 77%). Maximal LV wall thickness was related to the number of hypertrophied focal (17 mm), intermediate (20 mm) and diffuse (25 mm) LV segments (P=.0001). The researchers also reported that the number of hypertrophied LV segments was greater in patients with LV outflow tract obstruction vs. patients without obstruction (10 vs. 8, P<.001). In addition, patients with NYHA functional class III or IV HF symptoms had more hypertrophied segments that those without the HF symptoms vs. those with NYHA functional class II (n=9) or I (n=8) who were minimally symptomatic (P=.007). Left ventricular wall thickness was greater in segments with late gadolinium enhancement compared with the segments without late gadolinium enhancement (20 mm vs. 16 mm, P<.001).
“Contemporary CV magnetic resonance provides a measure of clarity to the morphology of hypertrophic cardiomyopathy and specifically the distribution and patterns of LV hypertrophy, which characterize the disease phenotype,” the researchers wrote in their conclusion. “While diverse, it is notable that the structural expression of the cardiomyopathic process in hypertrophic cardiomyopathy is often segmental and nondiffuse, and may also demonstrate noncontiguous patterns of wall thickness. Recognition that the anterior LV free wall is more commonly and often predominantly involved in the hypertrophic process than previously regarded (and can also be the sole area of all thickening) represents an important principle for the noninvasive diagnosis of hypertrophic cardiomyopathy.” – by Eric Raible
For more information:
- Maron M. J Am Coll Cardiol. 2009;54:220-228.