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Left ventricular function in patients with hypertrophic cardiomyopathy and its relation to myocardial fibrosis and

Dimitrios Maragiannis1, Paulino A Alvarez2, Mohamad G Ghosn2

  • 1Cardiovascular Imaging Section, 401 General Army Hospital of Athens, Athens, Greece.

The International Journal of Cardiovascular Imaging
|July 28, 2017
PubMed

Insights

In hypertrophic cardiomyopathy (HCM), increased myocardial extracellular volume (ECV) and native T1 relaxation time are linked to diastolic dysfunction. These changes correlate with reduced exercise capacity in HCM patients.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Biomedical Engineering

Background:

  • Hypertrophic cardiomyopathy (HCM) is a genetic heart disease characterized by abnormal thickening of the heart muscle.
  • Left ventricular (LV) diastolic dysfunction and reduced exercise tolerance are common clinical manifestations in HCM.
  • Myocardial extracellular volume (ECV) quantification using cardiac magnetic resonance (CMR) and native T1 relaxation times offer insights into myocardial tissue characteristics.

Purpose of the Study:

  • To investigate the relationship between myocardial ECV, LV diastolic function, and exercise tolerance in patients with HCM.
  • To assess differences in native T1 relaxation time and ECV between HCM patients and healthy controls.

Main Methods:

  • Forty-five HCM patients with preserved ejection fraction underwent CMR and transthoracic echocardiography.
  • CMR was utilized to measure LV volumes, mass, ejection fraction, LA volumes, scar burden, native T1, post-contrast T1, and ECV.
  • Echocardiography assessed outflow tract gradients, mitral inflow, annular velocities, circumferential strain, and diastolic strain rates. Exercise tolerance was evaluated by exercise duration and peak oxygen consumption.

Main Results:

  • HCM patients exhibited significantly increased native T1 relaxation time and ECV compared to controls.
  • Both native T1 relaxation time and ECV were significantly associated with LV diastolic dysfunction, circumferential strain, diastolic strain rate, and peak oxygen consumption.
  • Higher ECV and native T1 values correlated with worse diastolic function and reduced exercise tolerance.

Conclusions:

  • Increased myocardial ECV and native T1 relaxation time are prevalent in HCM patients with preserved ejection fraction.
  • These altered myocardial tissue properties are directly related to impaired LV diastolic function.
  • The structural changes contribute to diminished exercise capacity in individuals with HCM.

Keywords:
DiastoleFibrosisHypertrophic cardiomyopathy

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