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Myocardial Dimensions in Children With Hypertrophic Cardiomyopathy: A Comparison Between Echocardiography and Cardiac
Jonathan D Windram1, Andreea Dragelescu2, Lee Benson2
1The Labatt Family Heart Centre, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Transthoracic echocardiography (TTE) has limitations in assessing myocardial thickness in children with hypertrophic cardiomyopathy (HCM). Cardiac magnetic resonance (CMR) imaging offers more accurate and reproducible measurements than TTE.
Area of Science:
- Cardiology
- Pediatric Imaging
- Cardiovascular Disease
Background:
- Transthoracic echocardiography (TTE) is the primary imaging modality for hypertrophic cardiomyopathy (HCM).
- In adults, TTE's acoustic window limitations hinder accurate myocardial thickness quantification compared to cardiac magnetic resonance (CMR) imaging.
- Children may have better acoustic windows, potentially improving TTE accuracy for wall thickness in pediatric HCM.
Purpose of the Study:
- To evaluate the performance of TTE versus CMR for assessing myocardial thickness in pediatric patients with HCM.
- To compare the accuracy and reproducibility of TTE and CMR measurements in children diagnosed with HCM.
Main Methods:
- Nineteen children with known HCM underwent same-day TTE and CMR imaging.
- Left ventricular myocardial thickness was analyzed offline using a 16-segment model for both imaging modalities.
- Reproducibility was assessed using intraclass correlation coefficients (ICC).
Main Results:
- CMR allowed analysis of more segments (304) than TTE (263).
- TTE showed significant regional variations in wall thickness compared to CMR, with both under- and overestimations.
- CMR demonstrated excellent intra-reader and moderate inter-reader reproducibility, while TTE showed moderate intra-reader and poor inter-reader reproducibility.
Conclusions:
- TTE provides incomplete assessment of myocardial thickness in a subset of pediatric HCM patients.
- CMR imaging is more reproducible than TTE for myocardial thickness measurements in children with HCM.
- CMR is superior to TTE for accurate and reproducible assessment of myocardial thickness in pediatric HCM.
Background:
The primary mode of imaging in hypertrophic cardiomyopathy (HCM) is transthoracic echocardiography (TTE). However, in adults inadequate acoustic windows lead to poor quantification of myocardial thickness compared with cardiac magnetic resonance (CMR) imaging. In comparison, children have better acoustic windows and TTE measurements of wall thickness might be more accurate. The aim of this study was to assess the performance of TTE compared with CMR for the assessment of myocardial thickness in children with HCM.
Methods:
Nineteen children (median age, 12.7 years; range, 8.4-18.4 years) with known HCM were studied using TTE and CMR imaging on the same day. The left ventricle was measured off-line using the standard 16-segment model.
Results:
With CMR imaging 304 (19 × 16) segments were analyzable whereas only 263 were analyzable using echocardiography. Wall thickness measurements according to TTE were greater than those according to CMR imaging in the basal anterolateral, midventricular anterior and anterolateral and apical inferior, lateral and septal segments and smaller for the midventricular inferior and inferoseptal segments. Reproducibility of CMR and TTE measurements was assessed using the intraclass correlation coefficient (ICC). CMR measurements showed excellent intrareader (ICC, 0.929-0.991) and moderate inter-reader (ICC range, 0.512-0.991) reproducibility. TTE measurements revealed moderate intrareader (ICC, 0.575-0.942) and poor inter-reader (ICC range, -1.02 to 0.939) reproducibility.
Conclusions:
Echocardiography incompletely assesses circumferential myocardial thickness in a proportion of pediatric patients with HCM. Echocardiography under- and overestimates maximum wall thickness compared with CMR, depending on the location. Measurements using CMR are more reproducible than those obtained using echocardiography.
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