Role of cardiovascular magnetic resonance in the clinical evaluation of left ventricular hypertrophy: a 360° panorama

Abstract

Left ventricular hypertrophy (LVH) is a frequent imaging finding in the general population. In order to identify the precise etiology, a comprehensive diagnostic approach should be adopted, including the prevalence of each entity that may cause LVH, family history, clinical, electrocardiographic and imaging findings. By providing a detailed evaluation of the myocardium, cardiovascular magnetic resonance (CMR) has assumed a central role in the differential diagnosis of left ventricular hypertrophy, with the technique of parametric imaging allowing more refined tissue characterization. This article aims to establish a parallel between pathophysiological features and imaging findings through the broad spectrum of LVH entities, emphasizing the role of CMR in the differential diagnosis. Keywords Left ventricular hypertrophy • Cardiovascular magnetic resonance • Differential diagnosisLeft ventricular hypertrophy (LVH) is a frequent imaging finding in the general population, as detected by imaging [1,2]. Unless it is a physiological adaptation, LVH is clinically relevant since it constitutes a marker of adverse prognosis including major cardiovascular events [3,4]. However, LVH

Screening approaches to cardiac amyloidosis in different clinical settings: Current practice and future perspectives

“…In fact, in addition to the morphological and functional assessment of myocardial walls, CMR offers tissue characterization by measuring native T1 and native T2 (possibly with corresponding quantitative values in T1 mapping and T2 mapping) and extra-cellular volume (ECV). Those three measures have been proven in many studies to add both a diagnostic and prognostic value, even in distinguishing AL and ATTR amyloidosis ( 42 , 43 ).…”

Value of cardiac magnetic resonance on the risk stratification of cardiomyopathies

“…The “athlete’s heart” is characterized by biventricular, symmetrical remodelling, and is associated to a concomitant and proportional increase in cavity size[ 26 , 27 ]. Specific reference values of ventricular size and function for athletes have been reported by D’Ascenzi et al [ 27 ] In athletes, the degree of hypertrophy is usually mild, and LV wall thickness rarely exceeds 12 mm[ 28 ]. Moreover, reversal of adaptative LVH can be achieved with detraining[ 29 ].…”

“…This pattern of fibrosis does not affect prognosis nor requires further evaluation in otherwise healthy athletes[ 30 ]. Mapping data may further differentiate “athlete’s heart” from HCM: While the latter is usually associated with increased native T1 and ECV (reflecting interstitial fibrosis)[ 28 , 30 ], these parameters are normal, or even decreased, in athletes. Although echocardiography remains the major imaging tool for athlete pre-participation screening, CMR can be paramount in situations where suspicious of myocardial disease persists based on symptoms, family history, electrocardiographic or echocardiographic data.…”

“…Morphofunctional evaluation: The “classical” HCM phenotype consists of asymmetrical, septal-predominant hypertrophy, that may be associated to dynamic LV tract obstruction (LVOTO)[ 31 ]. In hypertrophied hearts, CMR enables precise measurement of maximal wall thickness and an accurate portrayal of LVH pattern, extent and distribution[ 28 ]. This is of particular importance in the presence of midventricular or apical variants of HCM, in which echocardiographic evaluation encounters limitations[ 23 ].…”

“…T1 mapping and ECV (derived from native and post-contrast T1) allow for identification of diffuse, interstitial fibrosis[ 23 ]. Native T1 and ECV may be elevated in segments without LGE, and even in variant carriers without overt LVH[ 28 ]. Mapping techniques allow differentiation of HCM from phenocopies (Table 1 ).…”