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J Am Coll Cardiol, 2003; 41:1561-1567, doi:10.1016/S0735-1097(03)00189-X
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH

Toward clinical risk assessment inhypertrophic cardiomyopathy withgadolinium cardiovascular magnetic resonance

James C. C. Moon, MB, BCh*, William J. McKenna, FACC, FESC{dagger}, Jane A. McCrohon, FRACP, PhD*, Perry M. Elliott, MD, MRCP, FACC{dagger}, Gillian C. Smith, BSc*{dagger} and Dudley J. Pennell, MD, FRCP, FESC, FACC*,*

* Centre for Advanced Magnetic Resonance in Cardiology (CAMRIC), Royal Brompton Hospital, London, United Kingdom
{dagger} Department of Cardiological Sciences, St. George’s Hospital Medical School, London, United Kingdom

Manuscript received May 20, 2002; revised manuscript received September 25, 2002, accepted October 4, 2002.

* Reprint requests and correspondence: Dr. Dudley J. Pennell, Professor of Cardiology, CMR Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
d.pennell{at}ic.ac.uk

OBJECTIVES: We sought to assess whether hyperenhancement by gadolinium cardiovascular magnetic resonance (CMR) occurs in hypertrophic cardiomyopathy (HCM) and correlates with the risk of heart failure and sudden death.

BACKGROUND: The myocardial interstitium is abnormal in HCM at post-mortem. Focally increased interstitial myocardial space appears as hyperenhancement with gadolinium CMR.

METHODS: In a blinded, prospective study, HCM patients were selected for the presence (n = 23) or absence (n = 30) of an increased clinical risk of sudden death and/or progressive adverse left ventricular (LV) remodeling. Gadolinium-enhanced CMR was performed.

RESULTS: Myocardial hyperenhancement was found in 42 patients (79%), affecting 10.9% (range 0% to 48%) of the LV mass. There was a greater extent of hyperenhancement in patients with progressive disease (28.5% vs. 8.7%, p < 0.001) and in patients with two or more risk factors for sudden death (15.7% vs. 8.6%, p = 0.02). Improved discrimination was seen in patients >40 years old (29.6% vs. 6.7%, p < 0.001) for progressive disease and for patients <40 years old for risk factors for sudden death (15.7% vs. 2.1%, p = 0.002). Patients with diffuse rather than confluent enhancement had two or more risk factors for sudden death (87% vs. 33%, p = 0.01).

CONCLUSIONS: Gadolinium CMR reveals myocardial hyperenhancement in HCM. The extent of hyperenhancement is associated with progressive ventricular dilation and markers of sudden death.

Abbreviations and Acronyms
  CMR = cardiovascular magnetic resonance
  DTPA = diethylenetriaminepentaacetic acid
  FISP = fast imaging with steady-state precession
  HCM = hypertrophic cardiomyopathy
  LV = left ventricle/ventricular
  LVH = left ventricular hypertrophy




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