Cardiovascular magnetic resonance signs of ischemia in hypertrophic cardiomyopathy

Melacini, Paola; Corbetti, Francesco; Calore, Chiara; Pescatore, Valentina; Smaniotto, Gessica; Pavei, Andrea; Bobbo, F; Cacciavillani, Luisa; Iliceto, Sabino

doi:10.1016/j.ijcard.2007.06.023

Cited by 44 publications

(35 citation statements)

References 53 publications

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“…22,23 A study by AbdelAty et al identified 9 of 27 HCM patients (33%) to have visually apparent T2-signal abnormalities, a prevalence similar to the current study. They also identified spatial matching to regions of dense fibrosis.…”

Section: Discussionsupporting

confidence: 85%

“…22,23 However, no statistical differences were identified in baseline characteristics of those receiving and not receiving T2 imaging. The signal thresholds used in this study for defining abnormal T2 signal were extrapolated from studies at 1.5 T. 27 Further validation of optimal thresholds at 3-T field strengths is required.…”

Section: Limitationsmentioning

confidence: 94%

“…T2-weighted imaging was added after the initiation of the study (after patient 27), when the presence of T2-weighted imaging abnormalities in HCM was first described. 22,23 Cine imaging was performed using a standard SSFP-based pulse sequence in sequential short-axis slices from the atrioventricular annulus to apex at 10-mm intervals, as well as in the 4-, 3-, and 2-chamber orientations (typical parameters: slice thickness, 6 mm; gap, 4 mm; matrix, 256×205, TE, 1.5 ms; temporal resolution, 35-40 ms). T2-weighted imaging was performed in sequential short-axis orientations using a triple inversion recovery fast spin echo sequence, performed both with and without the use of body surface coils.…”

Section: Cmr Imaging Protocolmentioning

confidence: 99%

“…It was not an aim to identify the prevalence of such findings relative to normal individuals because this has been addressed by previous studies. 22,23,38,41 Of particular note, T2 abnormalities are recognized to be rare in healthy controls.…”

Section: Limitationsmentioning

confidence: 99%

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Stress Hypoperfusion and Tissue Injury in Hypertrophic Cardiomyopathy

Tyan

Armstrong

Scholl

et al. 2013

Circ: Cardiovascular Imaging

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Background— Ischemia and tissue injury are common in patients with hypertrophic cardiomyopathy. Cardiovascular magnetic resonance imaging offers combined evaluations of each phenomenon at sufficiently high resolution to examine transmural spatial distribution. In this prospective cohort study, we examine the spatial distribution of stress perfusion abnormalities and tissue injury in patients with hypertrophic cardiomyopathy. Methods and Results— One hundred consecutive patients with hypertrophic cardiomyopathy underwent cardiovascular magnetic resonance imaging. Cine, stress perfusion, late gadolinium enhancement, and T2-weighted imaging techniques were used. Each was spatially coregistered according to predefined segmental and subsegmental models and was blindly analyzed for abnormalities using validated techniques. Spatial associations among stress perfusion, late gadolinium enhancement, and T2 imaging were made at segmental and subsegmental levels. Of the 100 patients studied, the phenotype was septal in 86 and apical in 14. Late gadolinium enhancement imaging was abnormal in 79 patients (79%). Eighty-six patients met prespecified safety criteria to undergo stress perfusion, and ischemia was identified in 46 patients (57%). T2 imaging was available in 81 patients and was abnormal in 19 (29%). The dominant distribution of all 3 findings was to segment with hypertrophy. Subsegmental analysis revealed geographic dominance of ischemia within the subendocardial zones. However, this zone was most commonly spared from late gadolinium enhancement and T2 abnormalities, typically seen in midwall and subepicardial zones. Conclusions— Inducible hypoperfusion is a common finding in hypertrophic cardiomyopathy and is typically identified within segments exhibiting imaging markers of tissue injury. However, the respective transmural dominance of these phenomena seems distinct. Alternate factors contributing to a regional susceptibility to tissue injury are deserving of further study.

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Section: Discussionsupporting

confidence: 85%

Section: Limitationsmentioning

confidence: 94%

Section: Cmr Imaging Protocolmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Stress Hypoperfusion and Tissue Injury in Hypertrophic Cardiomyopathy

Tyan

Armstrong

Scholl

et al. 2013

Circ: Cardiovascular Imaging

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“…The pattern of edema is often patchy and may indicate acute or recent myocardial ischemia, which is a known component of HCM. Histopathologically, this can also include necrosis, neutrophilic infiltrations, and myocytolysis [38,39].…”

Section: Primary Cardiomyopathiesmentioning

confidence: 99%

Myocardial Edema Imaging by Cardiovascular Magnetic Resonance: Current Status and Future Potential

Carbone

Friedrich

2011

Curr Cardiol Rep

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Cardiovascular magnetic resonance (CMR) imaging is widely established, free of radioactive material or ionizing radiation, and the accepted noninvasive gold standard for numerous noninvasive cardiac markers. Using a technique called T2-weighted imaging, CMR can be used to assess myocardial edema as a reliable marker for acute, potentially reversible myocardial injury. Contrast agents are not required as the myocardial free water content affects the magnetic properties of the tissue, thus providing inherent image contrast. In this review, we illustrate the utility of T2-weighted techniques in the assessment of myocardial edema in a range of clinical scenarios. The detection of myocardial edema is clinically relevant in many acute settings and may be further helpful to better understand the pathophysiology of many non-acute clinical diseases. Currently, T2-weighted CMR represents the only imaging modality that can accurately depict and quantify the presence of myocardial edema in a noninvasive fashion. Thus, T2-weighted imaging should be included in a comprehensive CMR imaging protocol, especially if an acute injury is suspected.

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Abnormalities in T2‐weighted cardiovascular magnetic resonance images of hypertrophic cardiomyopathy: Regional distribution and relation to late gadolinium enhancement and severity of hypertrophy

Abdel-Aty

Cocker

Strohm

et al. 2008

Magnetic Resonance Imaging

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Purpose:To explore if focal T2 abnormalities accompany late gadolinium enhancement (LGE) lesions in hypertrophic cardiomyopathy (HCM). Materials and Methods:All studies were performed under the guidelines of the local ethics committee, which approved the study, and a written informed consent was obtained from each subject. We studied 27 patients (24 males, 51 Ϯ 18 years) with HCM and evidence for myocardial injury as defined by LGE. The following sequences were performed: steady-state free precession (SSFP) (ventricular volumes, mass, and function), T2-weighted triple inversion-recovery spin-echo and inversion-recovery gradientecho 10 minutes after intravenous (IV) gadolinium-DTPA (late enhancement).Results: Focal high T2 signal intensity (SI) frequently matching areas of LGE was observed in nine patients (33%). The presence of these abnormalities correlated with more severe left ventricular hypertrophy (1.5 Ϯ 0.6 vs. 1.0 Ϯ 0.4 g/cm; P Ͻ 0.05). Conclusion:In this observational study, we identified focal T2 abnormalities in a subgroup of HCM patients. T2 abnormalities are associated with severe left ventricular hypertrophy. This may provide new insights into the mechanisms of focal irreversible injury in HCM and help in managing these patients.

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Cardiovascular magnetic resonance signs of ischemia in hypertrophic cardiomyopathy

Cited by 44 publications

References 53 publications

Stress Hypoperfusion and Tissue Injury in Hypertrophic Cardiomyopathy

Stress Hypoperfusion and Tissue Injury in Hypertrophic Cardiomyopathy

Myocardial Edema Imaging by Cardiovascular Magnetic Resonance: Current Status and Future Potential

Abnormalities in T2‐weighted cardiovascular magnetic resonance images of hypertrophic cardiomyopathy: Regional distribution and relation to late gadolinium enhancement and severity of hypertrophy

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