MR Imaging in Hypertrophic Cardiomyopathy: From Magnet to Bedside

Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries

“…These findings were sometimes accompanied by diffuse LV oedema and mild foci of midventricular or subepicardial enhancement on LGE images. [20][21][22] Hypertrophic CM was diagnosed in cases showing a focal or diffuse wall thickness of $18 mm and an increased normalized myocardial mass, along with the presence of areas of fibrosis within the thickened myocardium. 20,21,23 Cardiac amyloidosis was diagnosed in cases exhibiting concentric hypertrophy of the right and left myocardium and thickening of valve leaflets, atrial walls and septum, as well as LGE imaging results showing global or subendocardial enhancement of these structures.…”

“…[20][21][22] Hypertrophic CM was diagnosed in cases showing a focal or diffuse wall thickness of $18 mm and an increased normalized myocardial mass, along with the presence of areas of fibrosis within the thickened myocardium. 20,21,23 Cardiac amyloidosis was diagnosed in cases exhibiting concentric hypertrophy of the right and left myocardium and thickening of valve leaflets, atrial walls and septum, as well as LGE imaging results showing global or subendocardial enhancement of these structures. 21,24 Arrhythmogenic right ventricular cardiomyopathy (ARVC) was diagnosed in cases that showed a right ventricular akinesia or dyskinesia or dyssynchronous right ventricular contraction.…”

“…20,21,23 Cardiac amyloidosis was diagnosed in cases exhibiting concentric hypertrophy of the right and left myocardium and thickening of valve leaflets, atrial walls and septum, as well as LGE imaging results showing global or subendocardial enhancement of these structures. 21,24 Arrhythmogenic right ventricular cardiomyopathy (ARVC) was diagnosed in cases that showed a right ventricular akinesia or dyskinesia or dyssynchronous right ventricular contraction. Other major criteria for ARVC diagnosis were as follows: a ratio of right ventricular end-diastolic volume to BSA of $110 ml m 22 for males or of $100 ml m 22 for females, or a right ventricular ejection fraction of #40%.…”

Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosis

“…cMR imaging provides indeed the unique opportunity to non-invasively evaluate all these features during a single examination. Besides quantifying biventricular function parameters and LV wall thickness with high accuracy and reproducibility, cMR is able to yield information about replacement fibrosis, through the use of late gadolinium enhancement (LGE) imaging, and interstitial fibrosis, through the use of T1 relaxation measurement techniques [14]. In addition, assessment of LV myocardial mechanics directly from cine cMR images is possible through the use of a recently introduced featuretracking cMR software system [15,16].…”

Hypertrophic Cardiomyopathy: New Evidence Since the 2011 American Cardiology of Cardiology Foundation and American Heart Association Guideline

“…For patients with evidence of hypertrophy, Bogaert and Olivotto have described strategic features of CMR that facilitate distinguishing HCM from Bphenocopies^-diseases with similar cardiac morphology but vastly dissimilar etiology and clinical implications, such as glycogen storage diseases, amyloidosis, and others [9]. Late gadolinium enhancement (LGE) of the left ventricular myocardium is found in approximately half of patients with HCM, but also occurs in patients with infiltrative cardiomyopathies.…”