Association of myocardial fibrosis, electrocardiography and ventricular tachyarrhythmia in hypertrophic cardiomyopathy: A delayed contrast enhanced MRI study

Deborah H. Kwon, Randolph M. Setser, Zoran B. Popović, Maran Thamilarasan, Srikanth Sola, Paul Schoenhagen, Mario J. Garcia, Scott D. Flamm, Harry M. Lever, Milind Y. Desai

Research output: Contribution to journalArticle

99 Scopus citations

Abstract

Background: Patients with hypertrophic cardiomyopathy (HCM) are predisposed to ventricular tachyarrhythmia (VT); likely due to myocardial fibrosis or disarray. Delayed hyperenhancement magnetic resonance imaging (DHE-MRI) accurately detects myocardial fibrosis (scar). We sought to determine the association between septal thickness, myocardial scar and VT. Methods: Sixty-eight patients (mean age 44 years, 69% males) with documented HCM underwent cine MRI (Siemens Sonata or Avanto 1.5 T scanner, Erlangen, Germany) in short axis, 2, 3 and 4-chamber views and maximal interventricular septal thickness was recorded at end-diastole. Corresponding DHE-MR images (8-10 mm thick) were obtained, ̃20 min after injection of 0.2 mmol/kg of Gadolinium. Scar was determined semi-automatically (as % of total myocardium) using VPT software (Siemens) and defined as intensity >2 SD above viable myocardium in a 12 segment short-axis model at apex, mid LV and base. Presence of VT (documented on ambulatory ECG monitoring) and history of sudden death were recorded. Results: One patient had a history of sudden death and 9(13%) had VT on ambulatory ECG monitoring. On DHE-MRI, 39 (57%) patients had myocardial scar. Patients with VT had significantly higher scar %, compared to those without: 14% [6, 19] vs. 6% [0, 10], P = 0.01. On logistic regression, only the size of the scar was a significant predictor of VT (P = 0.03). Conclusions: HCM subjects with VT have a higher % of myocardial scarring noted on DHE-MRI, independent of septal thickness or beta-blocker use.

Original languageEnglish (US)
Pages (from-to)617-625
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Volume24
Issue number6
DOIs
StatePublished - Aug 2008
Externally publishedYes

Keywords

  • Delayed hyperenhancement
  • Electrocardiography
  • Hypertrophic cardiomyopathy
  • Magnetic resonance imaging
  • Ventricular tachyarrhythmia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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