Abstract Background: Recurrent myocardial ischemia has been recognized as playing an important role in the pathophysiology of hypertrophic cardiomyopathy (HCM) and cardiovascular magnetic resonance (CMR), with or without gadolinium, is a promising method of evaluating fibrosis, edema and hypoperfusion. The aim of this study is to evaluate the interrelationship between late enhancement (LE) and other signs of ischemia, such as edema and perfusion defects, and to relate them to clinical data in order to describe the stage of the disease. Methods: Forty-four patients were evaluated by CMR cine images, T2-weighted sequences for edema and LE sequences. First-pass perfusion studywas obtained in 37 patients. Acute-subacute ischemic eventswere clinically defined as the presence of chest pain or new onset of ST-segment depression, end-stage phase by left ventricular ejection fraction b50% and maximal left ventricular wall thickness b25 mm. Results: Intramural patchy LE was found in 35/44 (80%) patients; extensive LE in 4/44 (9%). Edema was present in 24/44 (54%) patients and perfusion defects in 17/37 (46%). Simultaneous presence of patchy LE, edema and hypoperfusion in corresponding segments, was significantly associated to acute–subacute ischemic-phase parameters (p=0.02; RR 1.99, 95% C.I. 0.77–5.02). Extensive LE and perfusion defects in the absence of edema were significantly related to end-stage HCM (pb0.001; RR 13.7, 95% C.I. 1.83–102.05). Conclusions: Using CMR in patients with HCM, we found focal tissue abnormalities consistent with regional ischemia at various stages. CMR provides important, clinically relevant information on the acuity, extent and functional relevance of ischemic injuries in HCM. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Hypertrophic cardiomyopathy; Myocardial ischemia; Magnetic resonance imaging

Cardiovascular magnetic resonance signs of ischemia in hypertrophic cardiomyopathy.

MELACINI, PAOLA;CALORE, CHIARA;PESCATORE, VALENTINA;PAVEI, ANDREA;CACCIAVILLANI, LUISA;ILICETO, SABINO
2008

Abstract

Abstract Background: Recurrent myocardial ischemia has been recognized as playing an important role in the pathophysiology of hypertrophic cardiomyopathy (HCM) and cardiovascular magnetic resonance (CMR), with or without gadolinium, is a promising method of evaluating fibrosis, edema and hypoperfusion. The aim of this study is to evaluate the interrelationship between late enhancement (LE) and other signs of ischemia, such as edema and perfusion defects, and to relate them to clinical data in order to describe the stage of the disease. Methods: Forty-four patients were evaluated by CMR cine images, T2-weighted sequences for edema and LE sequences. First-pass perfusion studywas obtained in 37 patients. Acute-subacute ischemic eventswere clinically defined as the presence of chest pain or new onset of ST-segment depression, end-stage phase by left ventricular ejection fraction b50% and maximal left ventricular wall thickness b25 mm. Results: Intramural patchy LE was found in 35/44 (80%) patients; extensive LE in 4/44 (9%). Edema was present in 24/44 (54%) patients and perfusion defects in 17/37 (46%). Simultaneous presence of patchy LE, edema and hypoperfusion in corresponding segments, was significantly associated to acute–subacute ischemic-phase parameters (p=0.02; RR 1.99, 95% C.I. 0.77–5.02). Extensive LE and perfusion defects in the absence of edema were significantly related to end-stage HCM (pb0.001; RR 13.7, 95% C.I. 1.83–102.05). Conclusions: Using CMR in patients with HCM, we found focal tissue abnormalities consistent with regional ischemia at various stages. CMR provides important, clinically relevant information on the acuity, extent and functional relevance of ischemic injuries in HCM. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Hypertrophic cardiomyopathy; Myocardial ischemia; Magnetic resonance imaging
File in questo prodotto:
Non ci sono file associati a questo prodotto.
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2440853
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 40
  • ???jsp.display-item.citation.isi??? 38
social impact