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Geometric assessment of asymmetric septal hypertrophic cardiomyopathy by CMR

Anca Florian1, Pier Giorgio Masci, Stijn De Buck

  • 1Department of Radiology, UZ Leuven, Leuven, Belgium.

JACC. Cardiovascular Imaging
|July 14, 2012
PubMed

Insights

This study reveals that most hypertrophic cardiomyopathy (HCM) patients exhibit a spiral pattern of hypertrophy (HT). This counterclockwise spiral, visualized with cardiac magnetic resonance (CMR), offers new insights into HCM

Area of Science:

  • Cardiology
  • Medical Imaging
  • 3D Visualization

Background:

  • Hypertrophic cardiomyopathy (HCM) presents with diverse phenotypes.
  • Cardiac magnetic resonance (CMR) is a powerful tool for 3D imaging of HCM.
  • Understanding the geometric patterns of hypertrophy is crucial for characterizing HCM.

Purpose of the Study:

  • To analyze the geometric pattern of hypertrophy (HT) in asymmetrical septal HCM using CMR.
  • To investigate if HT follows a longitudinal spiral pattern in HCM patients.
  • To correlate spiral HT patterns with clinical characteristics.

Main Methods:

  • Utilized short-axis cine CMR to assess 3D hypertrophy extent (radial, circumferential, longitudinal).
  • Included patients with septal wall thickness ≥15 mm and septal to free wall ratio >1.3.
  • Analyzed the relationship between circumferential and longitudinal hypertrophy extent.

Main Results:

  • 86% of 132 patients showed a consistent longitudinal course of HT, often a counterclockwise spiral.
  • The spiral pattern originated at the basal anteroseptum with variable rotation (mean 116°).
  • Greater rotation was associated with older age, LV outflow tract obstruction, and hypertension.

Conclusions:

  • The majority of asymmetrical septal HCM patients display a counterclockwise (left-handed) spiral hypertrophy pattern.
  • Significant variability exists in the magnitude of this spiral pattern.
  • Further research is needed to link spiral patterns to genetics, hemodynamics, and patient outcomes.
Abstract

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