Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy
Lubna Choudhury, MD, MRCP*,
Heiko Mahrholdt, MD*,
Anja Wagner, MD*,
Kelly M. Choi, MD*,
Michael D. Elliott, MD*,
Francis J. Klocke, MD, MACC*,
Robert O. Bonow, MD, FACC*,
Robert M. Judd, PhD* and
Raymond J. Kim, MD, FACC*,*
* Feinberg Cardiovascular Research Institute, Department of Medicine, Northwestern University, Chicago, Illinois, USA
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Figure 1 Typical images obtained by magnetic resonance imaging (MRI) with superimposed segmental model. Segments were analyzed for diastolic wall thickness, systolic wall thickening, and the spatial extent of scar represented by hyperenhanced myocardium (outlined regions).
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Figure 2 Representative patient images. (A) Patient with asymmetric septal hypertrophy, maximum wall thickness of 20 mm, normal ejection fraction, and marked myocardial scarring (hyperenhancement shown by arrows). (B)Patient with greater hypertrophy (maximum wall thickness, 27 mm) but with less scarring. In both patients, there are multiple foci of scar, which are predominantly mid-myocardial in location and are not present in the lateral free wall. The long-axis cines images of Patient 19 demonstrate systolic anterior motion of the mitral valve, systolic flow turbulence in the left ventricular outflow tract, and mitral regurgitation. For the accompanying full-motion cines video corresponding to Figure 2, please see the following: The accompanying movie for Patient 1. The contrast image (still) for Patient 1. The accompanying movie for Patient 19. The contrast image (still) for Patient 19.
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Figure 3 Relationship between amount of scarring (% hyperenhancement of segment) and segmental wall thickness and thickening. The amount of scarring increases progressively in direct relation to wall thickness and in inverse relation to wall thickening (p < 0.05 for every pairwise comparison between increments in both thickness and thickening). Error bars represent standard error of the mean. The number of segments for each category are listed.
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Figure 4 Spatial distribution of the mean values for segmental wall thickness, wall thickening and scar extent (hyperenhancement) represented as grey-scale maps in basal, mid, and apical short-axis slices in all patients. Note that the thicker walls (basal and mid septum) have the least thickening. Scarring predominantly involves the mid-wall myocardium at the junctions of the interventricular septum and the right ventricular free wall (arrows).
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Figure 5 Relationship between total amount of myocardial scar (hyperenhancement) and the maximum left ventricular (LV) wall thickness, LV mass, and LV ejection fraction.
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