Assessment of Myocardial Fibrosis in Hypertrophic Cardiomyopathy by Cardiac Magnetic Resonance: Modalities and Clinical Applications

Abstract

<p>Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease caused by mutations in sarcomeric contractile proteins, characterized by cardiomyocytes disarray, interstitial fibrosis, increased arteriolar wall thickness and scarring.</p><p>Fibrosis could represent a substrate for the generation of malignant ventricular tachyarrhythmias, which represent the current pathway for sudden cardiac death and is responsible for passive diastolic dysfunction, that is the leading cause of dyspnea.</p><p>The aim of this review is to depict the increasingly role of cardiac magnetic resonance (CMR) for assessment of myocardial fibrosis in HCM. This article will briefly review the current status of the novel CMR techniques (the Late Gadolinium Enhancement and the emerging T1 mapping) for identification, characterization and quantization of myocardial fibrosis in HCM.</p><p>In addition, this review will discuss the most recent acquisition techniques, the new parameters and their possible clinical utility in diagnosis, therapeutic management and prognosis in HCM.</p>

Myocardial morphology in hypertrophic cardiomyopathy: the current state of the problem

“…This is accompanied by an increase of the distance between the capillaries and CMs (especially in the perinuclear regions), which reduces the efficiency of oxygen diffusion and leads to myocytes hypoxia. Ischemic coronary death of CMs exacerbates interstitial and perivascular fibrosis with blockade of many capillaries [62,63]. The total reduction in microvasculature causes an increase in peripheral resistance to blood flow in coronary arteries and their response in the form of remodeling and intimal thickening due to media proliferation of smooth muscle cells and collagen with a significant narrowing of the lumen [9,47,64].…”