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

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.