Berríos-Bárcenas E, Bustamante S, Palacios E, Alexanderson-Rosas E, Barrero A, Laínez-Zelaya J, Meave-González A

Language: Spanish
References: 12
Page: 94-102
PDF size: 909.89 Kb.

ABSTRACT

Objective: identify the morphological characteristics of hypertrophic cardiomyopathy evaluated by cardiac magnetic resonance and analyze the association between them and cardiovascular events.
Methodology: an historic cohort study of a Mexican population with hypertrophic cardiomyopathy evaluated by cardiac magnetic resonance at Instituto Nacional de Cardiología Ignacio Chávez (Mexico City) from August 2007 through October 2013. Cardiovascular measurements and postgadolinium delayed enhancement evaluations were conducted. An analysis of survival was conducted to predict: syncope, malignant ventricular arrhythmias, implantation of automatic defibrillator, hospitalization due to heart failure, and death from any cause during a 36-month follow-up period.
Results: 124 patients with ages of 40.1 ± 21.9 years, 55% men, were included. The population presented a median of 5 hypertrophic segments per patient with maximum thickness of 24.3 ± 6.8 mm. Delayed enhancement was observed in 85% of the patients and 35% presented obstruction of the left ventricular outflow tract; the former proved better for predicting event-free survival. There was a direct correlation between the number of segments with delayed enhancement and myocardial mass (p ‹ 0.05), maximum ventricular wall thickness (p ‹ 0.05) and number of hypertrophic segments (p ‹ 0.05), but not with the left ventricular ejection fraction.
Conclusion: delayed enhancement indicates a tendency to adverse events, which is not observed with traditional factors such as degree of obstruction of the left ventricular outflow tract and family history of sudden death. The extent of delayed enhancement is correlated with ventricular thickness and mass.

REFERENCES

1. Maron BJ. Hypertrophic Cardiomyopathy: Braunwald´s Heart Diseases. 9a. Edición. Philadelphia, PA, 2012. Cap. 69:1582-94.

2. Maron BJ, Casey SA, Poliac LC, et al. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 1999;281:650.

3. Maron MS, Olivotto I, Betocchi S, et al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med 2003;348:295.

4. Maron MS. Clinical Utility of Cardiovascular Magnetic Resonance in Hypertrophic Cardiomyopathy. Journal of Cardiovascular Magnetic Resonance 2012;14:13.

5. Maron MS, Maron BJ, et al. Hypertrophic Cardiomyopathy Phenotype Revisited After 50 Years With Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2009;54:220–8.

6. Morovasky G, et al. Myocardial Fibrosis in HCM. J Am Coll Cardiol Img 2013;6:587–96.

7. Green J, et al. Prognostic Value of Late Gadolinium Enhancement in Clinical Outcomes for Hypertrophic Cardiomyopathy. J Am Coll Cardiol Img 2012;5:370–7.

8. Devlin AM. et al. A comparison of MRI and echocardiography in hypertrophic cardiomyopathy. Br J Radiol 1999;72(855):258-64.

9. Posma JL, et al. Assessment of quantitative hypertrophy scores in hypertrophic cardiomyopathy: magnetic re sonance imaging versus echocardiography. Am Heart J 1996;132(5):1020-7.

10. Mahrholdt H, et al. Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Europ Heart J 2005;26:1461–74.

11. Soler R, et al. Magnetic resonance imaging of delayed enhancement in hypertrophic cardiomyopathy: relationship with left ventricular perfusion and contractile function. J Comput Assist Tomogr 2006;30(3):412-20.

12. Yamada M, et al. Frequency and distribution of late gadolinium enhancement in magnetic resonance imaging of patients with apical hypertrophic cardiomyopathy and patients with asymmetrical hypertrophic cardiomyopathy: a comparative study. Int J Cardiovasc Imaging 2009;25:131-138.