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CLINICAL RESEARCH: CARDIAC IMAGING

Noninvasive Detection of Fibrosis Applying Contrast-Enhanced Cardiac Magnetic Resonance in Different Forms of Left Ventricular Hypertrophy

Relation to Remodeling

Franz-Volhard-Klinik, Charite Campus Buch, HELIOS-Kliniken Berlin, Universitätsmedizin Berlin, Berlin, Germany

Manuscript received May 5, 2008; revised manuscript received July 24, 2008, accepted August 12, 2008.

^_* Reprint requests and correspondence: Dr. Andre Rudolph, Schwanebecker Chaussee 50, 13125 Berlin, Germany (Email: a.rudolph{at}charite.de).

Objectives: We aimed to evaluate the incidence and patterns of late gadolinium enhancement (LGE) in different forms of left ventricular hypertrophy (LVH) and to determine their relation to severity of left ventricular (LV) remodeling.

Background: Left ventricular hypertrophy is an independent predictor of cardiac mortality. The relationship between LVH and myocardial fibrosis as defined by LGE cardiovascular magnetic resonance (CMR) is not well understood.

Methods: A total of 440 patients with aortic stenosis (AS), arterial hypertension (AH), or hypertrophic cardiomyopathy (HCM) fulfilling echo criteria of LVH underwent CMR with assessment of LV size, weight, function, and LGE. Patients with increased left ventricular mass index (LVMI) resulting in global LVH in CMR were included in the study.

Results: Criteria were fulfilled by 83 patients (56 men, age 57 ± 14 years; AS, n = 21; AH, n = 26; HCM, n = 36). Late gadolinium enhancement was present in all forms of LVH (AS: 62%, AH: 50%; HCM: 72%, p = NS) and was correlated with LVMI (r = 0.237, p = 0.045). There was no significant relationship between morphological obstruction and LGE. The AS subjects with LGE showed higher LV end-diastolic volumes than those without (1.0 ± 0.2 ml/cm vs. 0.8 ± 0.2 ml/cm, p < 0.015). Typical patterns of LGE were observed in HCM but not in AS and AH.

Conclusions: Fibrosis as detected by CMR is a frequent feature of LVH, regardless of its cause, and depends on the severity of LV remodeling. As LGE emerges as a useful tool for risk stratification also in nonischemic heart diseases, our findings have the potential to individualize treatment strategies.

Key Words: cardiac magnetic resonance imaging • cardiomyopathy • late gadolinium enhancement • left ventricular hypertrophy

Abbreviations and Acronyms   AH = arterial hypertension   AS = aortic stenosis   CMR = cardiovascular magnetic resonance   EF = ejection fraction   HCM = hypertrophic cardiomyopathy   LGE = late gadolinium enhancement   LV = left ventricle/ventricular   LVEDVI = left ventricular end-diastolic volume index   LVH = left ventricular hypertrophy   LVMI = left ventricular mass index   RV = right ventricle/ventricular

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