This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Rudolph, A. Articles by Schulz-Menger, J. Search for Related Content PubMed PubMed Citation Articles by Rudolph, A. Articles by Schulz-Menger, J. Related Collections Related Articles

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

Related Articles

Left Ventricular Hypertrophy and Excess Cardiovascular Mortality: Is Late Gadolinium Enhancement the Imaging Link?

Michael L. Chuang and Warren J. Manning
J. Am. Coll. Cardiol. 2009 53: 292-294. [Full Text] [PDF]

This article has been cited by other articles:

				M. Saito, H. Okayama, T. Yoshii, H. Higashi, H. Morioka, G. Hiasa, T. Sumimoto, S. Inaba, K. Nishimura, K. Inoue, et al. Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy Eur Heart J Cardiovasc Imaging, January 12, 2012; (2012) jer318v1. [Abstract] [Full Text] [PDF]

				A. C. Y. To, A. Dhillon, and M. Y. Desai Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol. Img., October 1, 2011; 4(10): 1123 - 1137. [Abstract] [Full Text] [PDF]

				M. R. Dweck, S. Joshi, T. Murigu, F. Alpendurada, A. Jabbour, G. Melina, W. Banya, A. Gulati, I. Roussin, S. Raza, et al. Midwall Fibrosis Is an Independent Predictor of Mortality in Patients With Aortic Stenosis J. Am. Coll. Cardiol., September 13, 2011; 58(12): 1271 - 1279. [Abstract] [Full Text] [PDF]

				N. Mewton, C. Y. Liu, P. Croisille, D. Bluemke, and J. A. C. Lima Assessment of Myocardial Fibrosis With Cardiovascular Magnetic Resonance J. Am. Coll. Cardiol., February 22, 2011; 57(8): 891 - 903. [Abstract] [Full Text] [PDF]

				C. Parsai and S. K. Prasad 21 Heart failure imaged by cardiac magnetic resonance imaging Oxford Textbook of Heart Failure, January 1, 2011; 1(1): med-9780199577729-chapter - med-9780199577729-chapter. [Abstract] [Full Text]

				D. P. Leong, P. L. Madsen, and J. B. Selvanayagam Non-invasive evaluation of myocardial fibrosis: implications for the clinician Heart, December 15, 2010; 96(24): 2016 - 2024. [Full Text] [PDF]

				X. Song, Y. Kusakari, C.-Y. Xiao, S. D. Kinsella, M. A. Rosenberg, M. Scherrer-Crosbie, K. Hara, A. Rosenzweig, and T. Matsui mTOR attenuates the inflammatory response in cardiomyocytes and prevents cardiac dysfunction in pathological hypertrophy Am J Physiol Cell Physiol, December 1, 2010; 299(6): C1256 - C1266. [Abstract] [Full Text] [PDF]

				B. A. Austin, Z. B. Popovic, D. H. Kwon, M. Thamilarasan, T. Boonyasirinant, S. D. Flamm, H. M. Lever, and M. Y. Desai Aortic stiffness independently predicts exercise capacity in hypertrophic cardiomyopathy: a multimodality imaging study Heart, August 1, 2010; 96(16): 1303 - 1310. [Abstract] [Full Text] [PDF]

				C. M. Kramer Cardiac Magnetic Resonance Imaging Identification of Myocardial Fibrosis: The Need for Standardization and Therapies J. Am. Coll. Cardiol., July 20, 2010; 56(4): 288 - 289. [Full Text] [PDF]

				C. Jellis, J. Martin, J. Narula, and T. H. Marwick Assessment of Nonischemic Myocardial Fibrosis J. Am. Coll. Cardiol., July 6, 2010; 56(2): 89 - 97. [Abstract] [Full Text] [PDF]

				J. B. Seward and G. Casaclang-Verzosa Infiltrative Cardiovascular Diseases: Cardiomyopathies That Look Alike J. Am. Coll. Cardiol., April 27, 2010; 55(17): 1769 - 1779. [Abstract] [Full Text] [PDF]

				S. V. Raman The Hypertensive Heart: An Integrated Understanding Informed by Imaging J. Am. Coll. Cardiol., January 12, 2010; 55(2): 91 - 96. [Abstract] [Full Text] [PDF]

				T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure J. Am. Coll. Cardiol., October 6, 2009; 54(15): 1407 - 1424. [Abstract] [Full Text] [PDF]

				M. L. Chuang and W. J. Manning Left Ventricular Hypertrophy and Excess Cardiovascular Mortality: Is Late Gadolinium Enhancement the Imaging Link? J. Am. Coll. Cardiol., January 20, 2009; 53(3): 292 - 294. [Full Text] [PDF]

				M. J. Ball, N. Keenan, M. Lynch, S. Prasad, and D. A Gorog Identifying the aetiology of left ventricular hypertrophy in an athlete: importance of lifestyle modification. BMJ Case Reports, January 1, 2009; 2009: bcr1020081080 - bcr1020081080. [Abstract] [Full Text]