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FOCUS ISSUE: HYPERTROPHIC CARDIOMYOPATHY: CLINICAL RESEARCH

Aortic Stiffness Is Increased in Hypertrophic Cardiomyopathy With Myocardial Fibrosis

Novel Insights in Vascular Function From Magnetic Resonance Imaging

Thananya Boonyasirinant, MD^_*,, Prabhakar Rajiah, MD^_*, Randolph M. Setser, DSc^_*, Michael L. Lieber, MS, Harry M. Lever, MD, Milind Y. Desai, MD^_*, and Scott D. Flamm, MD^_*,,_*

^_* Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Division of Cardiology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

Manuscript received January 14, 2009; revised manuscript received March 10, 2009, accepted March 23, 2009.

^_* Reprint requests and correspondence: Dr. Scott D. Flamm, Cardiovascular Imaging Laboratory, J1-4, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195 (Email: flamms{at}ccf.org).

Objectives: The aim of the study was to determine if patients with hypertrophic cardiomyopathy (HCM), both with and without myocardial fibrosis, have altered aortic stiffness as assessed by magnetic resonance imaging (MRI) pulse wave velocity (PWV) measurements.

Background: Abnormal aortic stiffness implies an unfavorable prognosis and has been established in a variety of aortic diseases and ischemic cardiomyopathy. However, the relationship between aortic stiffness and HCM has not been studied previously.

Methods: The study was institutional review board approved and Health Insurance Portability and Accountability Act of 1996 compliant. Velocity-encoded MRI was performed in 100 HCM and 35 normal control subjects. PWV was determined between the mid-ascending and -descending thoracic aorta. Delayed-enhancement MRI was acquired for identification of myocardial fibrosis.

Results: Mean age was 52.4 years in HCM and 45.3 years in control subjects. The prevalence of myocardial fibrosis in HCM was 70%. PWV was significantly higher in HCM patients compared with control subjects (8.72 ± 5.83 m/s vs. 3.74 ± 0.86 m/s, p < 0.0001). PWV was higher (i.e., increased aortic stiffness) in HCM patients with myocardial fibrosis than in those without (9.66 ± 6.43 m/s vs. 6.51 ± 3.25 m/s, p = 0.005).

Conclusions: Increased aortic stiffness, as indicated by increased PWV, is evident in HCM patients, and is more pronounced in those with myocardial fibrosis. Further, aortic stiffening may adversely affect left ventricular performance. In addition, increased aortic stiffness correlates with myocardial fibrosis, and may represent another potentially important parameter for risk stratification in HCM, warranting further study.

Key Words: aortic stiffness • pulse wave velocity • hypertrophic cardiomyopathy • myocardial fibrosis • magnetic resonance imaging

Abbreviations and Acronyms   DE-MRI = delayed-enhancement magnetic resonance imaging   FOV = field of view   HCM = hypertrophic cardiomyopathy   LVOT = left ventricular outflow tract   MRI = magnetic resonance imaging/image   PWV = pulse wave velocity   TE = echo time   TR = repetition time   VENC-MRI = velocity-encoded magnetic resonance imaging/image

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