Abstract 12217: Clinical Impact of Late Gadolinium Enhancement to Differentiate End-Stage Phase of Hypertrophic Cardiomyopathy from Dilated Cardiomyopathy
Background: Differentiating between end-stage phase of hypertrophic cardiomyopathy (Es-HCM) and idiopathic dilated cardiomyopathy (DCM) is a diagnostic dilemma. Few studies have examined the morphological characteristics of late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in patients with Es-HCM, and the relationship between LGE and cardiac function is unknown.
Hypothesis: We wished to identify the morphological characteristics of LGE that differentiate patients with Es-HCM from those with DCM.
Methods and Results: CMR was performed on 26 patients with histologically proven Es-HCM and 27 patients with DCM using a 1.5 T MR system. The heart was divided into 29 segments, and each was assessed for LGE morphology and distribution. The LGE to normal signal intensity ratio (SIR) was calculated. The correlation between the number of LGE-positive segments and ventricular function was assessed. LGE was observed in all of the Es-HCM patients, whereas 93% of the DCM patients. In Es-HCM patients, LGE was predominantly located in the interventricular septum (IVS) with junctional areas between the right ventricle and left ventricle (LV), and these areas demonstrated patchy pattern (Fig.A). In contrast, in patients with DCM, LGE was demonstrated a linear pattern in the middle layer of IVS (Fig.B). The peak SIR was higher in patients with Es-HCM than those with DCM (4±1.4 vs.1.5±0.4, p<0.0001). Intriguingly, the number of LGE-positive segments negatively correlated with LV ejection fraction (r= −0.58) and positively correlated with LV volume index (r=0.65) but did not correlate with cardiac events (hospitalization for heat failure or ventricular arrhythmia) in Es-HCM patients.
Conclusion: In patients with Es-HCM, LGE demonstrates a transmurally distributed patchy pattern or is localized to the middle layer of IVS including junctional areas. Thus, assesment of LGE has the potential to provide valuable information to distinguish Es-HCM from DCM.
- © 2011 by American Heart Association, Inc.