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Published on: February 16, 2016
Delayed enhancement in hypertrophic cardiomyopathy: comparison with myocardial tagging MRI
Young Jin Kim1, Byoung Wook Choi, Jin Hur
1Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea.
Insights
Delayed enhancement (DE) in hypertrophic cardiomyopathy (HCM) is common and significantly impairs regional left ventricular function, especially with focal nodular patterns. This dysfunction occurs regardless of myocardial hypertrophy severity.
Area of Science:
- Cardiovascular Imaging
- Cardiac MRI Techniques
- Hypertrophic Cardiomyopathy Research
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart disease characterized by myocardial hypertrophy.
- Regional myocardial dysfunction is a hallmark of HCM, contributing to clinical symptoms.
- The relationship between myocardial scarring and regional function in HCM requires further elucidation.
Purpose of the Study:
- To investigate the association between delayed enhancement (DE) and regional left ventricular (LV) function in HCM patients.
- To utilize gadolinium-enhanced MRI and myocardial tagging MRI for comprehensive assessment.
- To determine if DE patterns correlate with the severity of regional dysfunction.
Main Methods:
- Cardiac MRI including cine, delayed enhancement (DE), and myocardial tagging sequences were performed in 25 HCM patients.
- DE was analyzed for location, pattern, and extent.
- Regional circumferential shortening (Ecc) was quantified using MR tagging and HARP software.
Main Results:
- Delayed enhancement (DE) was observed in 84% of HCM patients, frequently in the septum and RV attachment sites.
- Circumferential shortening (Ecc) was significantly reduced in DE-positive segments compared to DE-negative segments (P < 0.0001).
- Impaired circumferential shortening was more pronounced in segments with focal nodular DE than patchy DE (P = 0.0002), irrespective of wall thickness.
Conclusions:
- Delayed enhancement (DE) is a frequent finding in hypertrophic cardiomyopathy (HCM).
- Regional left ventricular function, specifically circumferential shortening, is significantly impaired in areas with DE, independent of hypertrophy.
- Focal nodular DE patterns are strongly associated with regional myocardial dysfunction in HCM.
Purpose:
To evaluate the relationship between delayed enhancement (DE) and regional left ventricular function in hypertrophic cardiomyopathy (HCM) using gadolinium enhancement MRI and myocardial tagging MRI.
Materials And Methods:
Cine imaging, delayed enhancement imaging, and tagging MRI were performed in 25 patients with HCM. The location, pattern, and extent of DE were evaluated. Circumferential shortening (Ecc) was obtained by analyzing MR tagging images with HARP software.
Results:
DE occurred in 21 (84%) patients with a high frequency of localization in the septum and the right ventricular attachment sites. Circumferential shortening was significantly decreased in the enhanced segments compared with nonenhanced segments (P < 0.0001). The myocardial wall was thicker in the enhanced segments than in the nonenhanced segments (P < 0.0001). However, circumferential shortening was significantly decreased in the enhanced segments of the same thickness (P < 0.0001). Circumferential shortening was more substantially impaired in the segments with focal nodular enhancement than those in the segments with ill-defined patchy enhancement (P = 0.0002).
Conclusion:
In HCM, DE is commonly found and circumferential shortening is significantly impaired in the regions with DE, regardless of the degree of myocardial hypertrophy. Focal nodular enhancement is particularly related with regional dysfunction in patients with HCM.
