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Microvascular dysfunction in hypertrophic cardiomyopathy evaluated by cardiac magnetic resonance and computed
Sergio Moral1, Leticia Fernandez-Friera, Javier Sanz
1Dept. of Cardiology, Hospital Universitario Doctor Josep Trueta, Girona, Spain. moral.sergio@yahoo.es
Insights
Hypertrophic cardiomyopathy (HCM) patients may experience chest pain due to microvascular dysfunction, leading to myocardial ischemia. Advanced imaging can identify risks associated with HCM progression and poor perfusion.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition.
- Chest pain evaluation is crucial for patients with HCM.
- Understanding the mechanisms of ischemia in HCM is vital.
Observation:
- A 36-year-old woman with HCM presented with chest pain.
- Stress cardiac MRI revealed severe anteroseptal hypertrophy and ischemia post-adenosine.
- Delayed enhancement imaging showed extensive hyperenhancement in hypertrophic segments.
Findings:
- No significant coronary artery disease was detected by CT angiography.
- Severe hypertrophy and ischemia were observed in the anteroseptal wall.
- Extensive myocardial hyperenhancement correlated with hypertrophic segments.
Implications:
- Microvascular dysfunction in HCM may predispose to myocardial ischemia and sudden death.
- The relationship between hypertrophy extent and perfusion reserve requires further investigation.
- Non-invasive imaging is valuable for risk stratification in HCM patients.
Abstract:
A 36-year-old woman with hypertrophic cardiomyopathy (HCM) was referred for the evaluation of chest pain. A stress cardiac magnetic resonance showed severe hypertrophy of the anteroseptal wall with severe ischaemia induced after adenosine infusion. LV size and function were normal. On delayed enhancement imaging, extensive, patchy areas of hyperenhancement in the hypertrophic segments were observed. A 64-slice computed tomography scan showed no evidence of significant coronary disease. Microvascular dysfunction in HCM may be a predisposing factor for myocardial ischaemia, leading to an increased risk of sudden death. However, the pathophysiological mechanisms remain largely unknown as well as whether the extension of the hypertrophy is associated with poor perfusion reserve. Non-invasive imaging modalities may be helpful in the identification of the underlying substrate determining the risk in these patients.
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