Distribution and Clinical Significance of High Signal Intensity of the Myocardium on T2-Weighted Images in 2 Phenotypes of Hypertrophic Cardiomyopathy

Amano, Yasuo; Aita, Kumiko; Yamada, Fumi; Kitamura, Mitsunobu; Kumita, Shin‐ichiro

doi:10.1097/rct.0000000000000296

Cited by 20 publications

(17 citation statements)

References 26 publications

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“…Importantly, whereas about 80% of patients did not show a postexercise rise in troponin, HighT2 could identify a subset of patients who were vulnerable to additional injury in almost 50%. The clinical potential of this differentiation requires further follow-up, which is supported by observations that HighT2 has been linked to a higher risk of non-sustained ventricular tachycardia and syncope 29 30. Ultimately, this distinction has the potential to contribute to more individualised recommendations.…”

Section: Discussionmentioning

confidence: 92%

Exercise and myocardial injury in hypertrophic cardiomyopathy

Cramer

Gommans

Dieker

et al. 2020

Heart

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ObjectiveTroponin and high signal intensity on T2-weighted (HighT2) cardiovascular magnetic resonance imaging (CMRi) are both markers of myocardial injury in hypertrophic cardiomyopathy (HCM). The interplay between exercise and disease development remains uncertain in HCM. We sought to assess the occurrence of postexercise troponin rises and its determinants.MethodsMulticentre project on patients with HCM and mutation carriers without hypertrophy (controls). Participants performed a symptom limited bicycle test with hs-cTnT assessment pre-exercise and 6 hours postexercise. Pre-exercise CMRi was performed in patients with HCM to assess measures of hypertrophy and myocardial injury. Depending on baseline troponin (< or >13 ng/L), a rise was defined as a >50% or >20% increase, respectively.ResultsTroponin rises occurred in 18% (23/127) of patients with HCM and 4% (2/53) in mutation carriers (p=0.01). Comparing patients with HCM with and without a postexercise troponin rise, maximum heart rates (157±19 vs 143±23, p=0.004) and maximal wall thickness (20 mm vs 17 mm, p=0.023) were higher in the former, as was the presence of late gadolinium enhancement (85% vs 57%, p=0.02). HighT2 was seen in 65% (13/20) and 19% (15/79), respectively (p<0.001). HighT2 was the only independent predictor of troponin rise (adjusted odds ratio 7.9; 95% CI 2.7 to 23.3; p<0.001).ConclusionsPostexercise troponin rises were seen in about 20% of patients with HCM, almost five times more frequent than in mutation carriers. HighT2 on CMRi may identify a group of particularly vulnerable patients, supporting the concept that HighT2 reflects an active disease state, prone to additional injury after a short episode of high oxygen demand.

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Section: Discussionmentioning

confidence: 92%

Exercise and myocardial injury in hypertrophic cardiomyopathy

Cramer

Gommans

Dieker

et al. 2020

Heart

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“…As we know varying amounts of fibrosis were frequently seen in hypertrophic cardiomyopathy (HCM), and can be detected by T1 mapping. But in some cases myocardial injuries also may be found in patients with HCM 38, 39 . We guess the reason why other groups have found higher correlations than ADC vs ECV is that the myocardial injuries may influence the excellular volume.…”

Section: Discussionmentioning

confidence: 99%

Fibrosis quantification in Hypertensive Heart Disease with LVH and Non-LVH: Findings from T1 mapping and Contrast-free Cardiac Diffusion-weighted imaging

et al. 2017

Sci Rep

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This study assessed the extent of fibrosis and the relationship between the ADC value and systolic strain in hypertensive patients with left ventricular hypertrophy (HTN LVH) and hypertensive patients without LVH (HTN non-LVH) using cardiac diffusion-weighted imaging and T1 mapping. T1 mapping was performed in 13 HTN LVH (mean age, 56.23 ± 3.30 years), 17 HTN non-LVH (mean age, 56.41 ± 2.78 years), and 12 normal control subjects (mean age, 55.67 ± 3.08 years) with 3.0 T MRI using cardiac diffusion-weighted imaging and T1 mapping. HTN LVH subjects had higher native T1 (1233.12 ± 79.01) compared with controls (1133.88 ± 27.40) (p < 0.05). HTN LVH subjects had higher ECV (0.28 ± 0.03) compared with HTN non-LVH subjects (0.26 ± 0.02) or controls (0.24 ± 0.03) (p < 0.05). HTN LVH subjects had higher ADC (2.23 ± 0.34) compared with HTN non-LVH subjects (1.88 ± 0.27) or controls (1.61 ± 0.38), (p < 0.05). Positive associations were noted between LVMI and ADC (Spearman = 0.450, p < 0.05) and between LVMI and ECV (Spearman = 0.181, p < 0.05). ADC was also related to an increase in ECV (R2 = 0.210). Increased levels of ADC were associated with reduced peak systolic and early diastolic circumferential strain rates across all subjects. Contrast-free DW-CMR is an alternative sequence to ECV for the evaluation of fibrosis extent in HTN LVH and HTN non-LVH, while native T1 has limited value.

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“…The presence of hyperintense signals on T2-weighted CMR images has recently been noted in HCM patients, with myocardial high T2 signal being significantly predictive of life-threatening arrhythmia in HCM patients [64][65][66]. Such signals have highlighted the areas of ischemic infarction after an acute myocardial attack, and ischemia is a common finding in HCM, due to the imbalance of the hypertrophic myocardium and blood supply to tissue [67,68].…”

Section: T2 Mapping In Hcmmentioning

confidence: 97%

Cardiac Mri in Cardiomyopathies

et al. 2021

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Heart failure affects 1–2% of the adult population and one of the main contributors to its development is cardiomyopathy. Assessing a patient's risk for adverse events in heart failure is challenging and made more difficult by the heterogenous phenotypic expression of the disease. Cardiac MRI has long been a gold standard measure of myocardial function and anatomy due to its high spatial and temporal resolution. More recently, it has been posited to play a more critical role in the diagnosis and prognosis of cardiomyopathy-related heart failure. Given the limitations of more commonly used imaging modalities, increasing the clinical use of cardiac magnetic resonance imaging could potentially improve the prognosis of specific subgroups of patients at risk of adverse cardiac events.

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Distribution and Clinical Significance of High Signal Intensity of the Myocardium on T2-Weighted Images in 2 Phenotypes of Hypertrophic Cardiomyopathy

Abstract: High signal intensity of the myocardium on T2-weighted images often locates outside LGE and reflects myocardial damage, which is related to syncope in ASH.

Cited by 20 publications

References 26 publications

Exercise and myocardial injury in hypertrophic cardiomyopathy

Exercise and myocardial injury in hypertrophic cardiomyopathy

Fibrosis quantification in Hypertensive Heart Disease with LVH and Non-LVH: Findings from T1 mapping and Contrast-free Cardiac Diffusion-weighted imaging

Cardiac Mri in Cardiomyopathies

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