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Published on: May 24, 2021
Cardiovascular Magnetic Resonance-Based Tissue Characterization in Patients With Hypertrophic Cardiomyopathy
Atish Vanmali1, Waleed Alhumaid2, James A White3
1Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada; Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Cardiovascular magnetic resonance (CMR) imaging offers advanced techniques to assess tissue health in hypertrophic cardiomyopathy (HCM). These methods help identify patients at higher risk for adverse cardiovascular events.
Area of Science:
- Cardiology
- Medical Imaging
- Genetics
Background:
- Hypertrophic cardiomyopathy (HCM) is a prevalent genetic heart condition affecting 1:200-1:500 individuals.
- Cardiovascular magnetic resonance (CMR) imaging is crucial for managing HCM, providing insights into tissue health and patient outcomes.
Purpose of the Study:
- To review contemporary cardiovascular magnetic resonance (CMR) imaging techniques for characterizing tissue health in hypertrophic cardiomyopathy (HCM).
- To highlight the value of these CMR techniques in identifying patients at elevated risk of future cardiovascular outcomes.
Main Methods:
- Review of established and emerging CMR techniques, including contrast and noncontrast methods.
- Discussion of late gadolinium enhancement (LGE) for myocardial fibrosis quantification.
- Exploration of T1 mapping for extracellular volume fraction estimation and noncontrast tissue health assessment.
- Consideration of water-sensitive imaging (T2-weighted, T2 mapping) for risk stratification.
- Inclusion of innovative multiparametric methods for comprehensive tissue characterization.
Main Results:
- Late gadolinium enhancement (LGE) is a cornerstone for identifying and quantifying myocardial fibrosis, predicting arrhythmic events.
- T1 mapping offers precise fibrosis quantification and potential noncontrast risk assessment.
- T2-weighted imaging and T2 mapping show promise in risk discrimination.
- Emerging multiparametric techniques enhance personalized HCM care through detailed tissue analysis.
Conclusions:
- CMR imaging provides a comprehensive suite of techniques for assessing tissue health in HCM patients.
- These advanced CMR methods are vital for risk stratification and guiding personalized management strategies in HCM.
- The continuous evolution of CMR techniques promises improved diagnostic and prognostic capabilities for hypertrophic cardiomyopathy.
Abstract:
Hypertrophic cardiomyopathy (HCM) is a common hereditable cardiomyopathy that affects between 1:200 to 1:500 of the general population. The role of cardiovascular magnetic resonance (CMR) imaging in the management of HCM has expanded over the past 2 decades to become a key informant of risk in this patient population, delivering unique insights into tissue health and its influence on future outcomes. Numerous mature CMR-based techniques are clinically available for the interrogation of tissue health in patients with HCM, inclusive of contrast and noncontrast methods. Late gadolinium enhancement imaging remains a cornerstone technique for the identification and quantification of myocardial fibrosis with large cumulative evidence supporting value for the prediction of arrhythmic outcomes. T1 mapping delivers improved fidelity for fibrosis quantification through direct estimations of extracellular volume fraction but also offers potential for noncontrast surrogate assessments of tissue health. Water-sensitive imaging, inclusive of T2-weighted dark blood imaging and T2 mapping, have also shown preliminary potential for assisting in risk discrimination. Finally, emerging techniques, inclusive of innovative multiparametric methods, are expanding the utility of CMR to assist in the delivery of comprehensive tissue characterization toward the delivery of personalized HCM care. In this narrative review we summarize the contemporary landscape of CMR techniques aimed at characterizing tissue health in patients with HCM. The value of these respective techniques to identify patients at elevated risk of future cardiovascular outcomes are highlighted.
