Abstract 10160: In Hypertrophic Cardiomyopathy the Presence of Edema is Associated With a More Advanced Stage of Disease
Introduction: Recurrent episodes of ischemia are generally considered to be a key factor in the development of fibrosis in the majority of patients with hypertrophic cardiomyopathy (HCM). As fibrosis may be a late manifestation of repeatedly injured myocardium in these patients, troponin release and edema might precede this more advanced stage of disease. Interestingly, both the presence of edema and troponin release have received little attention in patients with HCM.
Aim: To investigate the presence of edema in HCM and compare markers of myocardial injury between patients with and without edema.
Methods: HCM patients with no history of coronary artery disease were selected (n=84). Subjects underwent cardiac MRI (Philips Achieva, 1.5 Tesla) using cine MRI, late gadolinium enhancement and T2-weighted imaging to assess LV mass, maximal wall thickness and the presence and extent of fibrosis and edema. Cardiac troponin T was measured using a highly sensitive assay (Roche Diagnostics) (lower limit of detection = 3ng/L; 99th percentile = 14ng/L). HCM patients with and without edema were compared univariately.
Results: Signs of edema were present in 17/84 patients. Subjects with edema had significantly higher LV mass and maximal wall thickness. Fibrosis was present in 16/17 patients with edema. Troponin T was detectable in all, and elevated above 14ng/L in 11/17 patients with edema, more often than in patients without edema (Table). Among subjects with fibrosis, the extent of fibrosis was higher in patients with signs of edema (7 vs. 15% of LV mass).
Conclusions: Signs of edema are present in about 20% of HCM patients. Although it is suspected that edema precedes fibrosis, in our population imaging evidence of edema suggested a more advanced stage of disease, with more hypertrophy, a greater extent of fibrosis and higher troponin levels in these patients.
- © 2013 by American Heart Association, Inc.