CLINICAL RESEARCH
Toward clinical risk assessment inhypertrophic cardiomyopathy withgadolinium cardiovascular magnetic resonance
James C. C. Moon, MB, BCh*,
William J. McKenna, FACC, FESC ,
Jane A. McCrohon, FRACP, PhD*,
Perry M. Elliott, MD, MRCP, FACC,
Gillian C. Smith, BSc* and
Dudley J. Pennell, MD, FRCP, FESC, FACC*,*
* Centre for Advanced Magnetic Resonance in Cardiology (CAMRIC), Royal Brompton Hospital, London, United Kingdom
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.
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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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Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies
Eur. Heart J.,
August 1, 2005;
26(15):
1461 - 1474.
[Abstract]
[Full Text]
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J C Moon, J Mogensen, P M Elliott, G C Smith, A G Elkington, S K Prasad, D J Pennell, and W J McKenna
Myocardial late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy caused by mutations in troponin I
Heart,
August 1, 2005;
91(8):
1036 - 1040.
[Abstract]
[Full Text]
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P. Knaapen, W. G. van Dockum, O. Bondarenko, W. E.M. Kok, M. J.W. Gotte, R. Boellaard, A. M. Beek, C. A. Visser, A. C. van Rossum, A. A. Lammertsma, et al.
Delayed Contrast Enhancement and Perfusable Tissue Index in Hypertrophic Cardiomyopathy: Comparison Between Cardiac MRI and PET
J. Nucl. Med.,
June 1, 2005;
46(6):
923 - 929.
[Abstract]
[Full Text]
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S. V. Babu-Narayan, O. Goktekin, J. C. Moon, C. S. Broberg, G. A. Pantely, D. J. Pennell, M. A. Gatzoulis, and P. J. Kilner
Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries
Circulation,
April 26, 2005;
111(16):
2091 - 2098.
[Abstract]
[Full Text]
[PDF]
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A. S. Adabag, S. A. Casey, M. A. Kuskowski, A. G. Zenovich, and B. J. Maron
Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy
J. Am. Coll. Cardiol.,
March 1, 2005;
45(5):
697 - 704.
[Abstract]
[Full Text]
[PDF]
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C. J. Soriano, F. Ridocci, J. Estornell, J. Jimenez, V. Martinez, and J. A. De Velasco
Noninvasive diagnosis of coronary artery disease in patients with heart failure and systolic dysfunction of uncertain etiology, using late gadolinium-enhanced cardiovascular magnetic resonance
J. Am. Coll. Cardiol.,
March 1, 2005;
45(5):
743 - 748.
[Abstract]
[Full Text]
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A. M. Maceira, J. Joshi, S. K. Prasad, J. C. Moon, E. Perugini, I. Harding, M. N. Sheppard, P. A. Poole-Wilson, P. N. Hawkins, and D. J. Pennell
Cardiovascular Magnetic Resonance in Cardiac Amyloidosis
Circulation,
January 18, 2005;
111(2):
186 - 193.
[Abstract]
[Full Text]
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B. J. Maron, J.G. Seidman, and C. E. Seidman
Proposal for contemporary screening strategies in families with hypertrophic cardiomyopathy
J. Am. Coll. Cardiol.,
December 7, 2004;
44(11):
2125 - 2132.
[Abstract]
[Full Text]
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D. J. Pennell, U. P. Sechtem, C. B. Higgins, W. J. Manning, G. M. Pohost, F. E. Rademakers, A. C. van Rossum, L. J. Shaw, and E. K. Yucel
Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report
Eur. Heart J.,
November 1, 2004;
25(21):
1940 - 1965.
[Full Text]
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R. R. Edelman
Contrast-enhanced MR Imaging of the Heart: Overview of the Literature
Radiology,
September 1, 2004;
232(3):
653 - 668.
[Abstract]
[Full Text]
[PDF]
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J. C. C. Moon, E. Reed, M. N. Sheppard, A. G. Elkington, S. Ho, M. Burke, M. Petrou, and D. J. Pennell
The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy
J. Am. Coll. Cardiol.,
June 16, 2004;
43(12):
2260 - 2264.
[Abstract]
[Full Text]
[PDF]
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M. P Frenneaux
Assessing the risk of sudden cardiac death in a patient with hypertrophic cardiomyopathy
Heart,
May 1, 2004;
90(5):
570 - 575.
[Full Text]
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H. Mahrholdt, C. Goedecke, A. Wagner, G. Meinhardt, A. Athanasiadis, H. Vogelsberg, P. Fritz, K. Klingel, R. Kandolf, and U. Sechtem
Cardiovascular Magnetic Resonance Assessment of Human Myocarditis: A Comparison to Histology and Molecular Pathology
Circulation,
March 16, 2004;
109(10):
1250 - 1258.
[Abstract]
[Full Text]
[PDF]
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A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y. W. Lew, and S. Tsimikas
Highlights of the year in JACC 2003
J. Am. Coll. Cardiol.,
December 17, 2003;
42(12):
2156 - 2166.
[Full Text]
[PDF]
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J. C.C. Moon, B. Sachdev, A. G. Elkington, W. J. McKenna, A. Mehta, D. J. Pennell, P. J. Leed, and P. M. Elliott
Gadolinium enhanced cardiovascular magnetic resonance in Anderson-Fabry disease: Evidence for a disease specific abnormality of the myocardial interstitium
Eur. Heart J.,
December 1, 2003;
24(23):
2151 - 2155.
[Abstract]
[Full Text]
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B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, F. J. Ten Cate, et al.
American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines
J. Am. Coll. Cardiol.,
November 5, 2003;
42(9):
1687 - 1713.
[Full Text]
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Writing Committee Members, B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, et al.
American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines
Eur. Heart J.,
November 1, 2003;
24(21):
1965 - 1991.
[Full Text]
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J.A. McCrohon, J.C.C. Moon, S.K. Prasad, W.J. McKenna, C.H. Lorenz, A.J.S. Coats, and D.J. Pennell
Differentiation of Heart Failure Related to Dilated Cardiomyopathy and Coronary Artery Disease Using Gadolinium-Enhanced Cardiovascular Magnetic Resonance
Circulation,
July 8, 2003;
108(1):
54 - 59.
[Abstract]
[Full Text]
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