University of Bristol -Explore Bristol Research General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms 1 MANUSCRIPT Abstract ObjectivesEuropean guidelines state left ventricular (LV) end-diastolic wall thickness (EDWT) ≥15mm suggests hypertrophic cardiomyopathy (HCM), but distinguishing from hypertensive heart disease (HHD) is challenging. We identify cardiac magnetic resonance (CMR) predictors of HHD over HCM when EDWT ≥15mm. Methods consecutive clinicalCMRs between 2014-15 were reviewed. 464 segments from 29 HCM subjects with EDWT ≥15mm but without other cardiac abnormality, hypertension or renal impairment were analyzed. 432 segments from 27 HHD subjects with EDWT ≥15mm but without concomitant cardiac pathology were analyzed. Magnitude and location of maximal EDWT, presence of late gadolinium enhancement (LGE), LV asymmetry (>1.5-fold opposing segment) and systolic anterior motion of the mitral valve (SAM) were measured. Multivariate logistic regression was performed. Significance was defined as P<0.05. ResultsHHD and HCM cohorts were age-/gender-matched. HHD had significantly increased indexed LV mass (110±27g/m 2 vs 91±31g/m 2 , P=0.016) but no difference in site or magnitude of maximal EDWT. Mid-wall LGE was significantly more prevalent in HCM.Elevated indexed LVM, mid-wall LGE and absence of SAM were significant multivariate predictors of HHD, but LV asymmetry was not. 2 ConclusionsIncreased Indexed LV mass, mid-wall LGE and absence of SAM are better CMR discriminators of HHD from HCM than EDWT ≥15mm. Key wordsHypertension; Cardiomyopathy, Hypertrophic; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging; Cardiac Imaging Techniques Key points• Hypertrophic cardiomyopathy (HCM) is often diagnosed with end-diastolic wall thickness ≥15mm.• Hypertensive heart disease (HHD) can be difficult to distinguish from HCM.• Retrospective case-control study showed that location and magnitude of EDWT are poor discriminators.• Increased left ventricular mass, systolic anterior motion of the mitral valve and mid-wall fibrosis are independent predictor of HHD.• Cardiac magnetic resonance parameters facilitate a better discrimination between HHD and HCM.

Despite evidence of accurate targeting of lesions, the use of NCB instead of fine needle aspiration cytology has not eliminated the problem of false negative biopsy in RS/CSL, and excision is recommended.

Ducci, C. (2019). Native T1 mapping to detect extent of acute and chronic myocardial infarction: comparison with late gadolinium enhancement technique. Abstract Aim:Investigate whether native-T1 mapping can assess the transmural extent of myocardial infarction(TEI) thereby differentiating viable from non-viable myocardium without the use of gadolinium-contrast in both acute and chronic myocardial infarction(aMI and cMI). METHODS:60patients (30 cMI>1year and 30 aMI day2 STEMI) and 20 healthy-controls underwent 1.5T CMR to assess left ventricular function(cine), native-T1 mapping(MOLLI sequence 5(3)3, motion-corrected) and the presence and TEI from late gadolinium enhancement(LGE) images. Segments with <75% TEI was considered viable. Gold-standard LGE-TEI was compared with corresponding segmental native-T1. RESULTS:Segmental native-T1 correlated significantly with TEI(R= 0.74,p<0.001 in cMI and R=0.57,p<0.001 in aMI). Native-T1 differentiated segments with no LGE(1031±31ms), LGE positive but viable(1103±57ms) and LGE positive but non-viable(1206±118ms) in cMI(p<0.01). It also differentiated segments with no LGE(1054±65m), LGE positive but viable(1135±73ms) and LGE positive but non-viable(1168±71ms) in aMI(p<0.01). ROC analysis demonstrated excellent accuracy of native-T1 mapping compared to LGE-TEI(AUC-0.88,p <0.001 in cMI, vs AUC -0.83,p<0.001 in aMI). Native-T1 performed better in cMI than aMI(p<0.01). In cMI a segmental T1 threshold of 1085ms differentiated viable from nonviable segments with a sensitivity 88% and specificity of 88% whereas a T1 of 1110ms differentiated viable from nonviable with 79% sensitivity and 79% specificity in aMI. CONCLUSIONS:Native-T1 mapping correlates significantly with TEI thereby differentiating between normal, viable, and non-viable myocardium with distinctive T1 profiles in aMI and cMI. Native T1mapping to detect MI performed better in cMI compared to aMI due to absence of myocardial oedema. Native-T1 mapping holds promise for viability assessment without the need for gadolinium-contrast agent.

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