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CLINICAL RESEARCH: HYPERTROPHIC CARDIOMYOPATHY

Assessment and Significance of Left Ventricular Mass by Cardiovascular Magnetic Resonance in Hypertrophic Cardiomyopathy

Iacopo Olivotto, MD^_*,_*, Martin S. Maron, MD, Camillo Autore, MD, John R. Lesser, MD, Luigi Rega, MD^_*, Giancarlo Casolo, MD^_*, Marcello De Santis, MD, Giovanni Quarta, MD, Stefano Nistri, MD^_*, Franco Cecchi, MD^_*, Carol J. Salton, BA^||, James E. Udelson, MD, Warren J. Manning, MD^|| and Barry J. Maron, MD

^_* Regional Referral Center for Myocardial Diseases and Radiology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
Cardiology and Radiology Units, Ospedale Sant'Andrea, Università di Roma "La Sapienza," Rome, Italy
Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
Division of Cardiology, Tufts-New England Medical Center, Boston, Massachusetts
^|| Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, Massachusetts.

Manuscript received January 17, 2008; revised manuscript received April 17, 2008, accepted April 28, 2008.

^_* Reprint requests and correspondence: Dr. Iacopo Olivotto, Centro di Riferimento per le Cardiomiopatie, Cardiologia San Luca, Azienda Ospedaliera Universitaria Careggi, Viale Pieraccini 19, 50134 Firenze, Italy. (Email: olivottoi{at}ao-careggi.toscana.it).

Objectives: Our aim was to assess the distribution and clinical significance of left ventricular (LV) mass in patients with hypertrophic cardiomyopathy (HCM).

Background: Hypertrophic cardiomyopathy is defined echocardiographically by unexplained left ventricular wall thickening. Left ventricular mass, quantifiable by modern cardiovascular magnetic resonance techniques, has not been systematically assessed in this disease.

Methods: In 264 HCM patients (age 43 ± 18 years; 75% men), LV mass by cardiovascular magnetic resonance was measured, indexed by body surface area, and compared with that in 606 healthy control subjects.

Results: The LV mass index in HCM patients significantly exceeded that of control subjects (104 ± 40 g/m² vs. 61 ± 10 g/m² in men and 89 ± 33 g/m² vs. 47 ± 7 g/m² in women; both p < 0.0001). However, values were within the normal range ( mean +2 SDs for control subjects) in 56 patients (21%), and only mildly increased (mean +2 to 3 SDs) in 18 (16%). The LV mass index showed a modest relationship to maximal LV thickness (r² = 0.38; p < 0.001), and was greater in men (104 ± 40 g/m² vs. 89 ± 33 g/m² in women; p < 0.001) and in patients with resting outflow obstruction (121 ± 43 g/m² vs. 96 ± 37 g/m² in nonobstructives; p < 0.001). During a 2.6 ± 0.7-year follow-up, markedly increased LV mass index proved more sensitive in predicting outcome (100%, with 39% specificity), whereas maximal wall thickness >30 mm was more specific (90%, with 41% sensitivity).

Conclusions: In distinction to prior perceptions, LV mass index was normal in about 20% of patients with definite HCM phenotype. Therefore, increased LV mass is not a requirement for establishing the clinical diagnosis of HCM. The LV mass correlated weakly with maximal wall thickness, and proved more sensitive in predicting outcome.

Key Words: hypertrophic cardiomyopathy • cardiac magnetic resonance • left ventricular mass • hypertrophy • outcome

Abbreviations and Acronyms   BSA = body surface area   CMR = cardiovascular magnetic resonance   HCM = hypertrophic cardiomyopathy   LV = left ventricle/ventricular   OR = odds ratio

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