Cardiovascular Magnetic Resonance for the Differentiation of Left Ventricular Hypertrophy

Abstract

Purpose of Review Left ventricular hypertrophy (LVH) is a common presentation encountered in clinical practice with a diverse range of potential aetiologies. Differentiation of pathological from physiological hypertrophy can be challenging but is crucial for further management and prognostication. Cardiovascular magnetic resonance (CMR) with advanced myocardial tissue characterisation is a powerful tool that may help to differentiate these aetiologies in the assessment of LVH. Recent Findings The use of CMR for detailed morphological assessment of LVH is well described. More recently, advanced CMR techniques (late gadolinium enhancement, parametric mapping, diffusion tensor imaging, and myocardial strain) have been used. These techniques are highly promising in helping to differentiate key aetiologies of LVH and provide valuable prognostic information. Summary Recent advancements in CMR tissue characterisation, such as parametric mapping, in combination with detailed morphological assessment and late gadolinium enhancement, provide a powerful resource that may help assess and differentiate important causes of LVH.

Disclosing the cardiomyopathic substrate within the heart muscles in amyloidosis by cardiac magnetic resonance: diagnostic and prognostic implications

“…A global ECV increase around 0.40 should raise the suspicion of CA. In fact, ECV showed a tight incremental correlation with probability of cardiac involvement based on echocardiographic and biohumoral findings in AL [31] , and it agreed well with ECV measured by histology, representing a direct marker of the amyloid burden [20] .…”

“…Furthermore, the combination of atypical LGE and impaired strain, with a base-to-apex gradient by fast-SENC, demonstrated high accuracy for the differential diagnosis between HCM and CA [18] . However, the most important advantage of CMR is its unique non-invasive tissue characterization, which offers fundamental information on tissue composition, with histologic validation [19,20] . This is especially useful in patients with other causes of LV hypertrophy, differentiating CA from hypertensive heart disease, hypertrophic cardiomyopathy, or other infiltrative cardiomyopathies, which may be challenging by echocardiography [21] .…”

The impact of hypertension on the prognosis of patients with hypertrophic cardiomyopathy: a single-center retrospective study

“…The detection of dynamic LVOTO due to the SAM of the mitral valve and mitral-septal contact at rest or exertion, specific apical or apical-mild hypertrophy sparing the base also suggest the diagnosis of HCM. In addition, cardiac magnetic resonance (CMR) assessing the parameters of global longitudinal strain and late gadolinium enhancement (LGE) is also recommended to further differentiate the causes of LVH ( Neisius et al, 2019 ; Burrage & Ferreira, 2020 ).…”

Left Ventricular Hypertrophy and Ventricular Tachyarrhythmia: The Role of Biomarkers

“…The advantage of CMR is the use of advanced techniques for detailed morphological assessment of the myocardial tissue such as late gadolinium enhancement, parametric mapping, diffusion tensor imaging, and myocardial strain [ 20 ]. Thus, in patients with LVH, CMR provides a comprehensive and detailed evaluation of the degree and distribution of hypertrophy, ventricular function, and tissue morphological characterization, which are potentially promising as methods differentiating the etiology of LVH [ 20 ].…”