Document Detail

Cardiac magnetic resonance detection of myocardial scarring in hypertrophic cardiomyopathy: correlation with histopathology and prevalence of ventricular tachycardia.
MedLine Citation:
PMID:  19589437     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: In hypertrophic cardiomyopathy (HCM) patients undergoing surgical myectomy, we sought to determine the association between pre-operative cardiac magnetic resonance (CMR) findings, small intramural coronary arteriole dysplasia (SICAD) on histopathology, and ventricular tachycardia (VT). BACKGROUND: Myocardial scarring (fibrosis) and SICAD are frequently observed on histopathology in HCM patients. CMR measures wall thickness and detects scar. METHODS: Sixty symptomatic HCM patients (62% men; mean age 51 +/- 14 years), with preserved ejection fraction (mean 64 +/- 5%) and no angiographic coronary disease underwent CMR (cine and delayed post-contrast) using a Siemens 1.5 T scanner, followed by septal myectomy. Maximal basal septal thickness was recorded on cine CMR. Scar was determined (percentage of total myocardium) on delayed post-contrast CMR images and quantified as none, mild (0% to 25%), moderate (26% to 50%), or severe (>50%). VT was assessed using Holter monitoring. Degree of SICAD was determined (normal, mild, moderate, and severe) on histopathology of surgical specimen. RESULTS: SICAD and scar were seen in 45 (75%) and 38 (63%) patients, respectively. In 15 patients without SICAD, 12 (80%) had no scar; 23 (70%) patients with mild SICAD had mild scar on CMR. On multivariate analysis, degree of SICAD was independently associated with scar on CMR (Wald chi-square statistic: 6.8, p < 0.01). Patients with basal septal scar on CMR had higher VT frequency compared with those without (27% vs. 5%, p = 0.03). CONCLUSIONS: A strong association exists between degree of SICAD and myocardial scarring seen on CMR.
Deborah H Kwon; Nicholas G Smedira; E Rene Rodriguez; Carmela Tan; Randolph Setser; Maran Thamilarasan; Bruce W Lytle; Harry M Lever; Milind Y Desai
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  54     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-10     Completed Date:  2009-07-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  242-9     Citation Subset:  AIM; IM    
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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MeSH Terms
Cardiomyopathy, Hypertrophic / pathology*,  surgery,  ultrasonography
Confidence Intervals
Coronary Vessels / pathology
Fibrosis / diagnosis,  pathology,  surgery
Heart Septum / surgery
Logistic Models
Magnetic Resonance Imaging*
Middle Aged
Multivariate Analysis
Myocardium / pathology*
Odds Ratio
Ohio / epidemiology
Stroke Volume
Tachycardia, Ventricular / epidemiology,  pathology*,  ultrasonography
Ventricular Function, Left
Young Adult

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