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Extent of late gadolinium enhancement at right ventricular insertion points in patients with hypertrophic

Yinsu Zhu1, Eun-Ah Park, Whal Lee

  • 1Department of Radiology, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, Korea.

European Radiology
|January 19, 2015
PubMed

Insights

In hypertrophic cardiomyopathy (HCM), late gadolinium enhancement (LGE) at right ventricular insertion points (RVIP) is linked to higher left ventricular filling pressures. This RVIP-LGE extent independently predicts diastolic dysfunction in HCM patients.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Medical Diagnostics

Background:

  • Hypertrophic cardiomyopathy (HCM) is a primary genetic heart muscle disease.
  • Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) identifies myocardial scar tissue.
  • Right ventricular insertion points (RVIP) are areas of the myocardium susceptible to LGE in HCM.

Purpose of the Study:

  • To investigate the association between the extent of LGE at RVIP and left ventricular (LV) functional parameters in HCM patients.
  • To determine if RVIP-LGE is an independent predictor of diastolic dysfunction in HCM.

Main Methods:

  • Sixty-one HCM patients underwent echocardiography and CMR.
  • LGE extent was quantified at RVIP (% RVIP-LGE) and non-RVIP locations.
  • LV functional parameters, including E/E' and left atrial volume index (LAVI), were assessed.

Main Results:

  • RVIP-LGE was more frequent in non-apical HCMs and associated with higher E/E' (19.23±8.40 vs. 13.13±5.06) and increased LAVI.
  • RVIP-LGE extent correlated with LV diastolic dysfunction (E/E': r=0.45; LAVI: r=0.53) and lower LVEF (r=-0.42).
  • Non-RVIP-LGE extent showed no correlation with LV diastolic parameters.

Conclusions:

  • The extent of LGE at RVIPs in HCM patients is associated with increased estimated LV filling pressure.
  • RVIP-LGE is an independent predictor of diastolic dysfunction and chronic diastolic burden in HCM.
  • LGE at non-RVIP locations does not correlate with LV diastolic dysfunction in HCM.
Abstract

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