Details:

Alternative Title:
Circ Cardiovasc Imaging
Personal Author:
Aletras, Anthony H. ; Tilak, Gauri S. ; Hsu, Li-Yueh ; Arai, Andrew E.
Aletras, Anthony H. ; Tilak, Gauri S. ; Hsu, Li-Yueh ; Arai, Andrew E. Less -
Description:
Background

In HCM, myocardial abnormalities are commonly heterogeneous. Two patterns of LGE have been reported: a bright “confluent” and an intermediate intensity abnormality termed “diffuse,” each representing different degrees of myocardial scarring. We used MRI to study the relation between intramural cardiac function and the extent of fibrosis in HCM. The aim of this study was to determine whether excess collagen or myocardial scarring, as determined by late gadolinium enhancement (LGE) MRI, are the primary mechanisms leading to heterogeneous regional contractile function in patients with hypertrophic cardiomyopathy (HCM).

Methods and Results

Intramural left ventricular (LV) strain, transmural LV function, and regions of myocardial fibrosis/scarring were imaged in 22 patients with HCM using displacement encoding with stimulated echoes (DENSE), cine MRI and LGE. DENSE systolic strain maps were qualitatively and quantitatively compared with LGE images. Intramural systolic strain by DENSE was significantly depressed within areas of confluent and diffuse LGE but also in the core of the most hypertrophic non-enhanced segment (all p<0.001 vs. non-hypertrophied segments). DENSE demonstrated an unexpected inner rim of largely preserved contractile function and a non-contracting outer wall within hypertrophic segments in 91% of patients.

Conclusions

LGE predicted some but not all of the heterogeneity of intramural contractile abnormalities. This indicates that myocardial scarring or excess interstitial collagen deposition does not fully explain the observed contractile heterogeneity in HCM. Thus, myofibril disarray or other non-fibrotic processes affect systolic function in a large number of patients with HCM.


Subject:
[+]
Adolescent
Adult
Aged
Article
Cardiomyopathy, Hypertrophic
Contrast Media
DENSE
Displacement Encoding With Stimulated Echoes
Echocardiography
Female
Gadolinium DTPA
Humans
Hypertrophic Cardiomyopathy
Image Enhancement
Late Gadolinium Enhancement
Magnetic Resonance Imaging
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardial Contraction
Myocardial Function
Strain
Stroke Volume

Source:
Circ Cardiovasc Imaging. 4(4):425-434.
Pubmed ID:
21576279
Pubmed Central ID:
PMC3460377
Document Type:
Journal Article
Funding:
Z01 HL004607-09/NULL/Intramural NIH HHS/United States ; ZIA HL004607-11/NULL/Intramural NIH HHS/United States ; ZID HL006140-01/NULL/Intramural NIH HHS/United States ; Z01 HL004607-10/NULL/Intramural NIH HHS/United States ; ZIA HL004607-14/NULL/Intramural NIH HHS/United States ; ... More +
Z01 HL004607-09/NULL/Intramural NIH HHS/United States ; ZIA HL004607-11/NULL/Intramural NIH HHS/United States ; ZID HL006140-01/NULL/Intramural NIH HHS/United States ; Z01 HL004607-10/NULL/Intramural NIH HHS/United States ; ZIA HL004607-14/NULL/Intramural NIH HHS/United States ; Z01 HL004607-08 CE/CE/NCIPC CDC HHS/United States ; ZIA HL004607-12/NULL/Intramural NIH HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:814cc63ca920d18862028ce632c75200a700f9e0bcfb31688f8a91abb75dcba7
File Type:

Supporting Files

• 	nihms305065f4.jpg	jpeg
  	nihms305065f5.gif	gif
  	nihms305065f5.jpg	jpeg
  	nihms305065f6.gif	gif
  	nihms305065f6.jpg	jpeg
  	nihms305065f7a.gif	gif
  	nihms305065f7a.jpg	jpeg
  	nihms305065f7b.gif	gif
  	nihms305065f7b.jpg	jpeg
  	nihms305065f8.gif	gif
  	nihms305065.nxml	xml
  	nihms305065f8.jpg	jpeg
  	nihms305065f1.gif	gif
  	nihms305065f1.jpg	jpeg
  	nihms305065f2.gif	gif
  	nihms305065f2.jpg	jpeg
  	nihms305065f3.gif	gif
  	nihms305065f3.jpg	jpeg
  	nihms305065f4.gif	gif

More +