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Updated: Jan 2, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Inline perfusion mapping provides insights into the disease mechanism in hypertrophic cardiomyopathy
Claudia Camaioni1, Kristopher D Knott1,2, Joao B Augusto1,2
1Advanced Cardiac Imaging, Barts Health NHS Trust, London, UK.
Insights
Microvascular dysfunction is common in hypertrophic cardiomyopathy (HCM), affecting myocardial blood flow (MBF) even in normal-appearing segments. This dysfunction is linked to hypertrophy and late gadolinium enhancement (LGE), suggesting it may be an early disease marker.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Research
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex condition where small vessel disease and myocardial perfusion are not fully understood.
- Quantitative data on absolute myocardial blood flow (MBF) in HCM patients are limited.
- Cardiovascular magnetic resonance (CMR) offers advanced imaging capabilities for assessing cardiac function and structure.
Purpose of the Study:
- To investigate the relationship between myocardial perfusion, cardiac hypertrophy, and late gadolinium enhancement (LGE) in patients with HCM.
- To quantify absolute myocardial blood flow (MBF) using CMR-based fully quantitative perfusion mapping.
- To determine the extent of microvascular dysfunction in HCM.
Main Methods:
- 101 HCM patients and 30 controls underwent CMR perfusion mapping during adenosine stress and rest.
- Pixel-wise analysis calculated stress MBF, rest MBF, and myocardial perfusion reserve (MPR).
- MBF and MPR were correlated with segmental wall thickness and LGE findings.
Main Results:
- Reduced stress MBF and MPR were observed in HCM patients compared to controls.
- Globally, stress MBF decreased with increasing left ventricle mass.
- Segmentally, reduced MBF and MPR correlated with increased wall thickness and LGE.
- In 21% of HCM patients, stress MBF was lower than rest MBF (MPR <1), predominantly in subendocardial segments.
- Even apparently normal HCM segments showed reduced stress MBF and MPR compared to controls.
Conclusions:
- Microvascular dysfunction is prevalent in HCM and associated with hypertrophy and LGE.
- Myocardial perfusion abnormalities, including reduced MBF and MPR, are present even in segments without hypertrophy or LGE.
- These findings suggest that impaired myocardial perfusion may serve as an early indicator of disease progression in HCM.
Objective:
In patients with hypertrophic cardiomyopathy (HCM), the role of small vessel disease and myocardial perfusion remains incompletely understood and data on absolute myocardial blood flow (MBF, mL/g/min) are scarce. We measured MBF using cardiovascular magnetic resonance fully quantitative perfusion mapping to determine the relationship between perfusion, hypertrophy and late gadolinium enhancement (LGE) in HCM.
Methods:
101 patients with HCM with unobstructed epicardial coronary arteries and 30 controls (with matched cardiovascular risk factors) underwent pixel-wise perfusion mapping during adenosine stress and rest. Stress, rest MBF and the myocardial perfusion reserve (MPR, ratio of stress to rest) were calculated globally and segmentally and then associated with segmental wall thickness and LGE.
Results:
In HCM, 79% had a perfusion defect on clinical read. Stress MBF and MPR were reduced compared with controls (mean±SD 1.63±0.60 vs 2.30±0.64 mL/g/min, p<0.0001 and 2.21±0.87 vs 2.90±0.90, p=0.0003, respectively). Globally, stress MBF fell with increasing indexed left ventricle mass (R2 for the model 0.186, p=0.036) and segmentally with increasing wall thickness and LGE (both p<0.0001). In 21% of patients with HCM, MBF was lower during stress than rest (MPR <1) in at least one myocardial segment, a phenomenon which was predominantly subendocardial. Apparently normal HCM segments (normal wall thickness, no LGE) had reduced stress MBF and MPR compared with controls (mean±SD 1.88±0.81 mL/g/min vs 2.32±0.78 mL/g/min, p<0.0001).
Conclusions:
Microvascular dysfunction is common in HCM and associated with hypertrophy and LGE. Perfusion can fall during vasodilator stress and is abnormal even in apparently normal myocardium suggesting it may be an early disease marker.
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