Advertisement

Click here for more guidelines.

 
 




CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2009; 54:220-228, doi:10.1016/j.jacc.2009.05.006
© 2009 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (3)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Maron, M. S.
Right arrow Articles by Appelbaum, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Maron, M. S.
Right arrow Articles by Appelbaum, E.
Related Collections
Right arrowRelated Article

FOCUS ISSUE: HYPERTROPHIC CARDIOMYOPATHY: CLINICAL RESEARCH

Hypertrophic Cardiomyopathy Phenotype Revisited After 50 Years With Cardiovascular Magnetic Resonance

Martin S. Maron, MD*,*, Barry J. Maron, MD{dagger}, Caitlin Harrigan, BA*, Jacki Buros, BA{ddagger}, C. Michael Gibson, MD, MS{ddagger},§, Iacopo Olivotto, MD||, Leah Biller, BA{dagger}, John R. Lesser, MD{dagger}, James E. Udelson, MD*, Warren J. Manning, MD{ddagger},§ and Evan Appelbaum, MD{ddagger},§

* Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
{dagger} The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
{ddagger} PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, Massachusetts
§ Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
|| Regional Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy

Manuscript received February 13, 2009; revised manuscript received April 30, 2009, accepted May 5, 2009.

* Reprint requests and correspondence: Dr. Martin S. Maron, Tufts Medical Center, #70, 800 Washington Street, Boston, Massachusetts 02111 (Email: mmaron{at}tuftsmedialcenter.org).

Objectives: Our purpose was to characterize the pattern and distribution of left ventricular (LV) hypertrophy by cardiovascular magnetic resonance (CMR) to more precisely define phenotypic expression and its clinical implications in hypertrophic cardiomyopathy (HCM).

Background: Based on prior pathologic and 2-dimensional echocardiographic studies, HCM has been regarded as a disease characterized by substantial LV wall thickening.

Methods: Cine and late gadolinium enhancement CMR were performed in 333 consecutive HCM patients (age 43 ± 17 years).

Results: Basal anterior LV free wall and the contiguous anterior ventricular septum were the most commonly hypertrophied segments (n = 256; 77%). LV hypertrophy was focal (involving ≤2 segments [≤12% of LV]) in 41 patients (12%), intermediate (3 to 7 segments [13% to 49% of LV]) in 112 patients (34%), and diffuse (≥8 segments [≥50% of LV]) in 180 patients (54%); 42 patients (13%) showed hypertrophied segments separated by regions of normal thickness. The number of hypertrophied segments was greater in patients with LV outflow tract obstruction (≥30 mm Hg) than without (10 ± 4 vs. 8 ± 4 per patient; p = 0.0001) and was associated with an advanced New York Heart Association functional class (p = 0.007). LV wall thickness was greater in segments with late gadolinium enhancement than without (20 ± 6 mm vs. 16 ± 6 mm; p < 0.001). We also identified 40 (12%) of HCM patients with segmental LV hypertrophy largely confined to the anterolateral free wall, posterior septum, or apex, which was underestimated or undetected by echocardiography.

Conclusions: Although diverse, patterns of LV hypertrophy are usually not extensive in HCM, involving ≤50% of the chamber in about one-half the patients, and are particularly limited in extent in an important minority. Contiguous portions of anterior free wall and septum constituted the predominant region of wall thickening, with implications for clinical diagnosis. These observations support an emerging role for CMR in the contemporary evaluation of patients with HCM.

Key Words: hypertrophic cardiomyopathy • hypertrophy • magnetic resonance imaging • fibrosis

Abbreviations and Acronyms
  CMR = cardiovascular magnetic resonance
  HCM = hypertrophic cardiomyopathy
  LGE = late gadolinium enhancement
  LV = left ventricle/ventricular
  NYHA = New York Heart Association


Related Article

Inside This Issue
J. Am. Coll. Cardiol. 2009 54: A24. [Full Text] [PDF]



This article has been cited by other articles:


Home page
J Am Coll CardiolHome page
B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, H. Rakowski, et al.
2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol., December 13, 2011; 58(25): 2703 - 2738.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, H. Rakowski, et al.
2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol., December 13, 2011; 58(25): e212 - e260.
[Full Text] [PDF]


Home page
CirculationHome page
Writing Committee Members, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al.
2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation, December 13, 2011; 124(24): e783 - e831.
[Full Text] [PDF]


Home page
CirculationHome page
Writing Committee Members, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al.
2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation, December 13, 2011; 124(24): 2761 - 2796.
[Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
Writing Committee Members:*, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al.
2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): 1303 - 1338.
[Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
Writing Committee Members:*, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al.
2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): e153 - e203.
[Full Text] [PDF]


Home page
J Am Coll Cardiol ImgHome page
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]


Home page
J Am Coll CardiolHome page
I. Olivotto, F. Girolami, R. Sciagra, M. J. Ackerman, B. Sotgia, J. M. Bos, S. Nistri, A. Sgalambro, C. Grifoni, F. Torricelli, et al.
Microvascular Function Is Selectively Impaired in Patients With Hypertrophic Cardiomyopathy and Sarcomere Myofilament Gene Mutations
J. Am. Coll. Cardiol., August 16, 2011; 58(8): 839 - 848.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
M. S. Maron, I. Olivotto, C. Harrigan, E. Appelbaum, C. M. Gibson, J. R. Lesser, T. S. Haas, J. E. Udelson, W. J. Manning, and B. J. Maron
Mitral Valve Abnormalities Identified by Cardiovascular Magnetic Resonance Represent a Primary Phenotypic Expression of Hypertrophic Cardiomyopathy
Circulation, July 5, 2011; 124(1): 40 - 47.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
B. J. Maron, M. Yacoub, and J. A. Dearani
Benefits of surgery in obstructive hypertrophic cardiomyopathy: bring septal myectomy back for European patients
Eur. Heart J., May 1, 2011; 32(9): 1055 - 1058.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
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]


Home page
Int J EpidemiolHome page
H.-W. Hense
When size matters
Int. J. Epidemiol., February 1, 2011; 40(1): 5 - 7.
[Full Text] [PDF]


Home page
HeartHome page
A. A. Hagege, E. Caudron, T. Damy, R. Roudaut, A. Millaire, C. Etchecopar-Chevreuil, T.-C. Tran, F. Jabbour, C. Boucly, P. Prognon, et al.
Screening patients with hypertrophic cardiomyopathy for Fabry disease using a filter-paper test: the FOCUS study
Heart, January 15, 2011; 97(2): 131 - 136.
[Abstract] [Full Text] [PDF]


Home page
Oxford Textbook of Heart FailureHome page
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]


Home page
Am. J. Roentgenol.Home page
D. A. Bluemke
MRI of Nonischemic Cardiomyopathy
Am. J. Roentgenol., October 1, 2010; 195(4): 935 - 940.
[Abstract] [Full Text] [PDF]


Home page
RadioGraphicsHome page
E. J. Chun, S. I. Choi, K. N. Jin, H. J. Kwag, Y. J. Kim, B. W. Choi, W. Lee, and J. H. Park
Hypertrophic Cardiomyopathy: Assessment with MR Imaging and Multidetector CT
RadioGraphics, September 1, 2010; 30(5): 1309 - 1328.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, G. K. Feld, B. H. Greenberg, J. Hall, M. Hlatky, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, et al.
Highlights of the Year in JACC 2009
J. Am. Coll. Cardiol., January 26, 2010; 55(4): 380 - 407.
[Full Text] [PDF]


Home page
Br. J. Sports. Med.Home page
B J Maron
Distinguishing hypertrophic cardiomyopathy from athlete's heart physiological remodelling: clinical significance, diagnostic strategies and implications for preparticipation screening
Br. J. Sports Med., September 1, 2009; 43(9): 649 - 656.
[Abstract] [Full Text] [PDF]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement