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Age-dependent hypertrophy and fibrosis dynamics in hypertrophic cardiomyopathy: Insights from longitudinal CMR

Sebastian M Haberkorn1, Mukaram Rana1, Vitali Koch2

  • 1Goethe University Frankfurt, University Hospital, Department of Cardiology and Angiology, 60590, Frankfurt, Germany.

International Journal of Cardiology. Heart & Vasculature
|November 18, 2024
PubMed

Insights

Serial Cardiac Magnetic Resonance (CMR) in hypertrophic cardiomyopathy (HCM) shows increasing left ventricular mass and fibrosis, alongside declining ejection fraction, particularly in adolescents. These changes correlate with age and fibrosis extent, aiding risk identification.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Hypertrophic cardiomyopathy (HCM) is characterized by complex morphological and functional changes.
  • Understanding the temporal progression of these alterations is crucial for patient management and risk stratification.

Purpose of the Study:

  • To evaluate the longitudinal progression of morphological and functional changes in patients with hypertrophic cardiomyopathy (HCM) using Cardiac Magnetic Resonance (CMR).

Main Methods:

  • Retrospective analysis of serial 1.5 Tesla CMR scans in 32 HCM patients.
  • Quantification of left ventricular (LV) mass, septal wall thickness, and left atrial volume.
  • Volumetric assessment of Late Gadolinium Enhancement (LGE) using a 5-SD threshold.
  • Measurement of left and right ventricular ejection fractions (LVEF and RVEF).

Main Results:

  • Significant increases observed in LV mass (p=0.0001), septal wall thickness (p=0.01), LGE mass (p=0.006), and left atrial volume (p=0.0001) over an average follow-up of 5.2 years.
  • Significant decreases in LVEF (p=0.04) and RVEF (p=0.02).
  • HCM mass gain was independently associated with age and LGE mass (p=0.02 for both).
  • Adolescents showed a higher LV mass gain rate (6.0 g/year/BSA) compared to adults (1.7 g/year/BSA).
  • Positive correlation between LV mass and LGE mass (p=0.001); inverse relationship between LV mass gain and LGE mass gain rates (p=0.03).

Conclusions:

  • Morphological changes in HCM suggest an age-related balance between hypertrophy and fibrosis.
  • Tracking LV mass, fibrosis, and functional decline via CMR can help identify at-risk patients.
  • Ongoing follow-up studies are essential for comprehensive HCM management.
Abstract

Keywords:
Cardiac Magnetic Resonance (CMR)Hypertrophic Cardiomyopathy (HCM)Late Gadolinium Enhancement (LGE)Left Ventricular MassOutcomePrognosis

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