Delay enhancement patterns in apical hypertrophic cardiomyopathy by phase-sensitive inversion recovery sequence

Area of Science:

• Cardiology
• Medical Imaging
• Cardiovascular Diseases

Background:

• Apical hypertrophic cardiomyopathy (ApHCM) is a form of hypertrophic cardiomyopathy characterized by thickening of the left ventricular apex.
• Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) is a key imaging biomarker for myocardial scar and fibrosis.
• Phase-sensitive inversion recovery (PSIR) sequences are commonly used for LGE imaging due to their high contrast.

Purpose of the Study:

• To characterize the patterns and extent of LGE in patients with ApHCM using PSIR-CMR.
• To investigate the distribution of LGE within the left ventricle (LV) in ApHCM.
• To determine if LGE patterns in ApHCM correlate with adverse prognosis.

Main Methods:

• Forty patients with pure ApHCM underwent CMR with PSIR sequences.
• LGE images were analyzed using a 17-segment model.
• Total LGE volume was quantified as a percentage of LV myocardium (% LGE).

Main Results:

• LGE was detected in 75% of patients, occupying 4.9% of LV myocardium.
• LGE was predominantly found at the apex (70%) and the junction of left and right ventricles (30%).
• LGE extended beyond the apical segments and was observed in non-hypertrophied segments, even without apical LGE.

Conclusions:

• LGE in ApHCM is not confined to the hypertrophied apex and frequently involves other LV segments.
• The presence of LGE on CMR in ApHCM patients does not appear to be indicative of an adverse prognosis.
• CMR with PSIR is valuable for assessing the full extent of LGE in ApHCM.