Abnormal T2-STIR Magnetic Resonance in Hypertrophic Cardiomyopathy: A Marker of Advanced Disease and Electrical Myocardial Instability

Abstract

BackgroundMyocardial hyperintensity on T2-weighted short-tau inversion recovery (STIR) (HyT2) cardiac magnetic resonance (CMR) images has been demonstrated in patients with hypertrophic cardiomyopathy (HCM) and is considered a sign of acute damage. The aim of the current study was to evaluate the relationship between HyT2 and both a) markers of ventricular electrical instability and b) clinical and CMR parameters.MethodsSixty-five patients underwent a thorough clinical examination, consisting of 24-h ECG recording and CMR examination including functional evaluation, T2-STIR images and late gadolinium enhancement (LGE).ResultsHyT2 was detected in 27 patients (42%), and subjects with HyT2 showed a greater left ventricle (LV) mass index (p<0.001), lower LV ejection fraction (p = 0.05) and greater extent of LGE (p<0.001) compared to those without HyT2. Twenty-two subjects (34%) presented non-sustained ventricular tachycardia (NSVT) on the 24-h ECG recording, 21 (95%) of whom exhibited HyT2. Based on the logistic regression analysis, HyT2 (odds ratio [OR]: 165, 95% CI 11–2455, p<0.001) and LGE extent (1.1, 1.0–1.3, p<0.001) served as independent predictors of NSVT, while the presence of LGE was not associated with NSVT occurrence (p = 0.49). The presence of HyT2 was associated with lower heart rate variability (p = 0.006) and a higher number of arrhythmic risk factors (p<0.001).ConclusionsIn HCM patients, HyT2 upon CMR examination is associated with more advanced disease and increased arrhythmic burden.

High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy

“…Elevated hs-cTnT has been demonstrated in up to 50% of patients with HCM, and has been related to adverse remodelling and prognosis in HCM 6 7. HighT2 has been shown to be associated with malignant ventricular arrhythmias 10 11 14. The present report is the first to demonstrate an association between HighT2 and hs-cTnT, independent of LVMI.…”

Cardiovascular magnetic resonance T2* mapping for the assessment of cardiovascular events in hypertrophic cardiomyopathy

“…None could be detected for HF. Assuming T2* values to be influenced by relative ischaemia, previous studies have already detected an association of abnormal T2 signal as a sign for myocardial damage and arrhythmia 32 33. In general, the results of the additional parameter of fibrosis were in line with previous studies showing an increased risk of events for patients with fibrosis 12 28 34.…”

Exercise and myocardial injury in hypertrophic cardiomyopathy

“…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.…”