Cardiac magnetic resonance detection of myocardial scarring in hypertrophic cardiomyopathy: correlation with histopathology and prevalence of ventricular tachycardia

J Am Coll Cardiol. 2009 Jul 14;54(3):242-9. doi: 10.1016/j.jacc.2009.04.026.

Abstract

Objectives: In hypertrophic cardiomyopathy (HCM) patients undergoing surgical myectomy, we sought to determine the association between pre-operative cardiac magnetic resonance (CMR) findings, small intramural coronary arteriole dysplasia (SICAD) on histopathology, and ventricular tachycardia (VT).

Background: Myocardial scarring (fibrosis) and SICAD are frequently observed on histopathology in HCM patients. CMR measures wall thickness and detects scar.

Methods: Sixty symptomatic HCM patients (62% men; mean age 51 +/- 14 years), with preserved ejection fraction (mean 64 +/- 5%) and no angiographic coronary disease underwent CMR (cine and delayed post-contrast) using a Siemens 1.5 T scanner, followed by septal myectomy. Maximal basal septal thickness was recorded on cine CMR. Scar was determined (percentage of total myocardium) on delayed post-contrast CMR images and quantified as none, mild (0% to 25%), moderate (26% to 50%), or severe (>50%). VT was assessed using Holter monitoring. Degree of SICAD was determined (normal, mild, moderate, and severe) on histopathology of surgical specimen.

Results: SICAD and scar were seen in 45 (75%) and 38 (63%) patients, respectively. In 15 patients without SICAD, 12 (80%) had no scar; 23 (70%) patients with mild SICAD had mild scar on CMR. On multivariate analysis, degree of SICAD was independently associated with scar on CMR (Wald chi-square statistic: 6.8, p < 0.01). Patients with basal septal scar on CMR had higher VT frequency compared with those without (27% vs. 5%, p = 0.03).

Conclusions: A strong association exists between degree of SICAD and myocardial scarring seen on CMR.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cardiomyopathy, Hypertrophic / diagnostic imaging
  • Cardiomyopathy, Hypertrophic / pathology*
  • Cardiomyopathy, Hypertrophic / surgery
  • Confidence Intervals
  • Coronary Vessels / pathology
  • Echocardiography
  • Female
  • Fibrosis / diagnosis
  • Fibrosis / pathology
  • Fibrosis / surgery
  • Heart Septum / surgery
  • Humans
  • Logistic Models
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardium / pathology*
  • Odds Ratio
  • Ohio / epidemiology
  • Prevalence
  • Stroke Volume
  • Tachycardia, Ventricular / diagnostic imaging
  • Tachycardia, Ventricular / epidemiology
  • Tachycardia, Ventricular / pathology*
  • Ventricular Function, Left
  • Young Adult