Cardiac Magnetic Resonance Detection of Myocardial Scarring in Hypertrophic Cardiomyopathy. Correlation With Histopathology and Prevalence of Ventricular Tachycardia

Deborah H. Kwon, Nicholas G. Smedira, E. Rene Rodriguez, Carmela Tan, Randolph Setser, Maran Thamilarasan, Bruce W. Lytle, Harry M. Lever, Milind Y. Desai

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: In hypertrophic cardiomyopathy (HCM) patients undergoing surgical myectomy, we sought to determine the association between pre-operative cardiac magnetic resonance (CMR) findings, small intramural coronary arteriole dysplasia (SICAD) on histopathology, and ventricular tachycardia (VT). Background: Myocardial scarring (fibrosis) and SICAD are frequently observed on histopathology in HCM patients. CMR measures wall thickness and detects scar. Methods: Sixty symptomatic HCM patients (62% men; mean age 51 ± 14 years), with preserved ejection fraction (mean 64 ± 5%) and no angiographic coronary disease underwent CMR (cine and delayed post-contrast) using a Siemens 1.5 T scanner, followed by septal myectomy. Maximal basal septal thickness was recorded on cine CMR. Scar was determined (percentage of total myocardium) on delayed post-contrast CMR images and quantified as none, mild (0% to 25%), moderate (26% to 50%), or severe (>50%). VT was assessed using Holter monitoring. Degree of SICAD was determined (normal, mild, moderate, and severe) on histopathology of surgical specimen. Results: SICAD and scar were seen in 45 (75%) and 38 (63%) patients, respectively. In 15 patients without SICAD, 12 (80%) had no scar; 23 (70%) patients with mild SICAD had mild scar on CMR. On multivariate analysis, degree of SICAD was independently associated with scar on CMR (Wald chi-square statistic: 6.8, p <0.01). Patients with basal septal scar on CMR had higher VT frequency compared with those without (27% vs. 5%, p = 0.03). Conclusions: A strong association exists between degree of SICAD and myocardial scarring seen on CMR.

Original languageEnglish (US)
Pages (from-to)242-249
Number of pages8
JournalJournal of the American College of Cardiology
Volume54
Issue number3
DOIs
StatePublished - Jul 14 2009
Externally publishedYes

Keywords

  • cardiac magnetic resonance
  • hypertrophic cardiomyopathy
  • myocardial scarring
  • small intramural coronary arteriole dysplasia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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