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The Hypertrophic Cardiomyopathy Phenotype Viewed Through the Prism of Multimodality Imaging: Clinical and Etiologic

Ethan J Rowin1, Barry J Maron1, Martin S Maron1

  • 1Hypertrophic Cardiomyopathy Center and Research Institute, Tufts Medical Center, Boston, Massachusetts.

JACC. Cardiovascular Imaging
|December 23, 2019
PubMed

Insights

Advanced imaging techniques like echocardiography and cardiovascular magnetic resonance (CMR) are crucial for diagnosing hypertrophic cardiomyopathy (HCM). These methods help identify high-risk features and guide treatment decisions, leading to reduced mortality rates.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition requiring precise characterization.
  • Noninvasive imaging plays a vital role in assessing HCM's structural and functional abnormalities.

Purpose of the Study:

  • To highlight the comprehensive role of contemporary noninvasive imaging in evaluating hypertrophic cardiomyopathy.
  • To demonstrate how imaging guides risk stratification and therapeutic interventions in HCM patients.

Main Methods:

  • Utilized echocardiography and cardiovascular magnetic resonance (CMR) for detailed cardiac assessment.
  • Incorporated late gadolinium enhancement (LGE) for myocardial fibrosis detection.
  • Employed exercise (stress) echocardiography to assess outflow gradients.

Main Results:

  • Imaging precisely defines left ventricle (LV) wall thickness and identifies mitral valve and LV chamber abnormalities.
  • Late gadolinium enhancement (LGE) effectively characterizes myocardial fibrosis.
  • Novel high-risk indicators for sudden death, including LV apical aneurysm and extensive LGE, were identified.
  • Stress echocardiography differentiated obstructive from nonobstructive HCM.
  • Multimodality imaging facilitated selection for septal reduction therapy and surgical planning.

Conclusions:

  • Contemporary imaging provides a comprehensive assessment of HCM, aiding in risk stratification.
  • Imaging guides optimal patient selection for invasive therapies like myectomy and alcohol septal ablation.
  • Integrated imaging strategies contribute to a low HCM-related mortality rate.

Keywords:
cardiovascular magnetic resonanceechocardiographyheart failurehypertrophic cardiomyopathysudden death

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