Frequency and distribution of late gadolinium enhancement in magnetic resonance imaging of patients with apical hypertrophic cardiomyopathy and patients with asymmetrical hypertrophic cardiomyopathy: a comparative study

Abstract

Our aim was to compare the frequency and distribution of late gadolinium enhancement (LGE) on contrast MRI between hypertrophic cardiomyopathy (HCM) patients with apical hypertrophic cardiomyopathy (APH) and those with asymmetrical septal hypertrophy (ASH). We studied 66 patients with HCM (50 men and 16 women; average age: 58.8 +/- 29.8 years) who had undergone MRI. All the MRI examinations were performed using a 1.5 T system. LGE images were acquired using the inversion recovery segmented spoiled-gradient echo and phase-sensitive inversion recovery methods. We evaluated 17 segments of the left ventricle as defined by the American Heart Association criteria for LGE determination. LGE was detected at the junction of the right ventricle and the interventricular septum in 25 (73.5%) of the 34 HCM patients with ASH and in the apex of the heart in 13 (40.6%) of the 32 patients with APH. LGE-positive areas were more widely distributed in the case of the ASH group than in the case of the APH group. The distribution of LGE was clearly different between the two groups (Fisher's exact probability test, P = 0.0068). The number of LGE-positive cases and LGE-positive segments were significantly higher in the ASH group than in the APH group and there was a significant difference in the distribution of the LGE-positive areas between the two groups. LGE was mainly detected in the hypertrophied areas of the myocardium.

Association of ST elevation with apical aneurysm in hypertrophic cardiomyopathy

“…13 Therefore, definitive noninvasive diagnosis of ACM with or without apical aneurysm has some diagnostic and therapeutic implications. 13,14 Currently, the cardiovascular magnetic resonance imaging (CMR) is generally regarded as the gold-standard diagnostic test for HCM particularly in challenging HCM cases 15,16 ; however, it is not commonly used in daily practice.…”

Comparison of Long-Term Outcome between Apical and Asymmetric Septal Hypertrophic Cardiomyopathy

“…The diagnostic criterion for ApHCM was LV hypertrophy confined predominantly to the LV apex (only the apical 4 segments and the apical cap) with a maximal apical wall thickness of ≥15 mm or a ratio of maximal apical to posterior wall thickness of ≥1.5 at the end diastole, regardless of the presence of systemic hypertension [6,15,16]. The definition of ASHCM was based on the presence of a septal wall thickness of ≥15 mm and a septal to free wall thickness ratio of ≥1.3 in the absence of another disease that could justify the magnitude of hypertrophy [8,17,18]. Patients with mixed forms of HCM were excluded.…”

The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure

“…5) (72). It may also involve the apex in the apical variant of the disease (73). An exception to the patchy nature of LGE in HCM is in areas of burned-out myocardium, where the LV wall is typically thinned and enhancement may be full thickness.…”