"Speckled" ventricular septum in hypertrophic cardiomyopathy revisited after 30 years

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Hypertrophic cardiomyopathy (HCM) is a significant cardiovascular condition.
• Myocardial fibrosis is a key pathological feature in HCM, impacting cardiac function.
• Echocardiography, particularly "speckling" patterns, is often used to assess cardiac tissue characteristics.

Purpose of the Study:

• To investigate the relationship between echocardiographic "speckling" in the ventricular septum and myocardial fibrosis in HCM patients.
• To determine if echocardiographic "speckling" can accurately identify left ventricular scarring.
• To establish the most reliable imaging modality for diagnosing myocardial fibrosis in HCM.

Main Methods:

• Comparison of granular and reflective ultrasound patterns (speckling) in the ventricular septum.
• Assessment of myocardial fibrosis using contrast-enhanced cardiovascular magnetic resonance imaging (CE-CMR).
• Correlation analysis between echocardiographic findings and CE-CMR evidence of fibrosis.

Main Results:

• A highly inconsistent relationship was observed between echocardiographic "speckling" and myocardial fibrosis confirmed by CE-CMR.
• The "speckling" pattern in the ventricular septum does not accurately characterize left ventricular scarring in HCM.
• Echocardiographic "speckling" is likely an extraneous ultrasound signal pattern rather than indicative of fibrosis.

Conclusions:

• Echocardiographic "speckling" is an unreliable marker for myocardial fibrosis in hypertrophic cardiomyopathy.
• Contrast-enhanced cardiovascular magnetic resonance imaging (CE-CMR) is the gold standard for identifying myocardial fibrosis in HCM.
• Clinical decisions regarding myocardial fibrosis in HCM should rely on CE-CMR findings.