Document Detail


Spectrum and clinical significance of systolic function and myocardial fibrosis assessed by cardiovascular magnetic resonance in hypertrophic cardiomyopathy.
MedLine Citation:
PMID:  20599013     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In hypertrophic cardiomyopathy (HCM), the clinical significance attributable to the broad range of left ventricular (LV) systolic function, assessed as the ejection fraction (EF), is incompletely resolved. We evaluated the EF using cardiovascular magnetic resonance (CMR) imaging in a large cohort of patients with HCM with respect to the clinical status and evidence of left ventricular remodeling with late gadolinium enhancement (LGE). CMR imaging was performed in 310 consecutive patients, aged 42 +/- 17 years. The EF in patients with HCM was 71 +/- 10% (range 28% to 89%), exceeding that of 606 healthy controls without cardiovascular disease (66 +/- 5%, p <0.001). LGE reflecting LV remodeling showed an independent, inverse relation to the EF (B-0.69, 95% confidence interval -0.86 to -0.52; p <0.001) and was greatest in patients with an EF <50%, in whom it constituted a median value of 29% of the LV volume (interquartile range 16% to 40%). However, the substantial subgroup with low-normal EF values of 50% to 65% (n = 45; 15% of the whole cohort), who were mostly asymptomatic or mildly symptomatic (37 or 82% with New York Heart Association functional class I to II), showed substantial LGE (median 5% of LV volume, interquartile range 2% to 10%). This overlapped with the subgroup with systolic dysfunction and significantly exceeded that of patients with an EF of 66% to 75% and >75% (median 2% of the LV volume, interquartile range 1.5% to 4%; p <0.01). In conclusion, in a large cohort of patients with HCM, a subset of patients with low-normal EF values (50% to 65%) was identified by contrast-enhanced CMR imaging as having substantial degrees of LGE, suggesting a transition phase, potentially heralding advanced LV remodeling and systolic dysfunction, with implications for clinical surveillance and management.
Authors:
Iacopo Olivotto; Barry J Maron; Evan Appelbaum; Caitlin J Harrigan; Carol Salton; C Michael Gibson; James E Udelson; Christopher O'Donnell; John R Lesser; Warren J Manning; Martin S Maron
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-05     Completed Date:  2010-08-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  261-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010. Published by Elsevier Inc.
Affiliation:
Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. olivottoi@aou-careggi.toscana.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Cardiomyopathy, Hypertrophic / complications*
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Stroke Volume
Systole*
Ventricular Dysfunction / diagnosis*,  etiology*
Ventricular Remodeling

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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