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Hypertensive heart disease versus hypertrophic cardiomyopathy: multi-parametric cardiovascular magnetic resonance discriminators when end-diastolic wall thickness ≥ 15 mm

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Abstract

Objectives

European guidelines state left ventricular (LV) end-diastolic wall thickness (EDWT) ≥15mm suggests hypertrophic cardiomyopathy (HCM), but distinguishing from hypertensive heart disease (HHD) is challenging. We identify cardiovascular magnetic resonance (CMR) predictors of HHD over HCM when EDWT ≥15mm.

Methods

2481 consecutive clinical CMRs between 2014 and 2015 were reviewed. 464 segments from 29 HCM subjects with EDWT ≥15mm but without other cardiac abnormality, hypertension or renal impairment were analyzed. 432 segments from 27 HHD subjects with EDWT ≥15mm but without concomitant cardiac pathology were analyzed. Magnitude and location of maximal EDWT, presence of late gadolinium enhancement (LGE), LV asymmetry (>1.5-fold opposing segment) and systolic anterior motion of the mitral valve (SAM) were measured. Multivariate logistic regression was performed. Significance was defined as p<0.05.

Results

HHD and HCM cohorts were age-/gender-matched. HHD had significantly increased indexed LV mass (110±27g/m2 vs. 91±31g/m2, p=0.016) but no difference in site or magnitude of maximal EDWT. Mid-wall LGE was significantly more prevalent in HCM. Elevated indexed LVM, mid-wall LGE and absence of SAM were significant multivariate predictors of HHD, but LV asymmetry was not.

Conclusions

Increased indexed LV mass, absence of mid-wall LGE and absence of SAM are better CMR discriminators of HHD from HCM than EDWT ≥15mm.

Key Points

Hypertrophic cardiomyopathy (HCM) is often diagnosed with end-diastolic wall thickness ≥15mm.

Hypertensive heart disease (HHD) can be difficult to distinguish from HCM.

Retrospective case-control study showed that location and magnitude of EDWT are poor discriminators.

Increased left ventricular mass and midwall fibrosis are independent predictors of HHD.

Cardiovascular magnetic resonance parameters facilitate a better discrimination between HHD and HCM.

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Abbreviations

ESC:

European Society of Cardiology

HCM:

Hypertrophic cardiomyopathy

LV:

Left ventricular

EDWT:

End-diastolic wall thickness

HHD:

Hypertensive heart disease

CMR:

Cardiovascular magnetic resonance imaging

LVH:

Left ventricular hypertrophy

SAM:

Systolic anterior motion of the mitral valve / sub-valvular apparatus

eGFR:

Estimated glomerular filtration rate

SCD:

Sudden cardiac death

SSFP:

Steady state free precession

BSA:

Body surface area

RV:

Right ventricular

EDV:

End-diastolic volume

ESV:

End-systolic volume

SV:

Stroke volume

EF:

Ejection fraction

M/V:

Mass to volume ratio

LGE:

Late gadolinium enhancement

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Acknowledgments

The scientific guarantor of this publication is Dr Nathan Manghat. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the National Institute for Health Research Cardiovascular Biomedical Research Unit, Bristol Heart Institute. The views expressed are those of the authors and not necessarily those of the National Health Service, National Institute for Health Research, or Department of Health. JCLR: Clinical Society of Bath Postgraduate Research Bursary 2014 and Royal College of Radiologists Kodak Research Scholarship 2014. ECH: British Heart Foundation Grant IBSRF FS/11/1/28400. JFRP is supported by the British Heart Foundation. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported.

Methodology: retrospective, case-control study, performed at one institution.

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Correspondence to Jonathan C. L. Rodrigues.

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Rodrigues, J.C.L., Rohan, S., Ghosh Dastidar, A. et al. Hypertensive heart disease versus hypertrophic cardiomyopathy: multi-parametric cardiovascular magnetic resonance discriminators when end-diastolic wall thickness ≥ 15 mm. Eur Radiol 27, 1125–1135 (2017). https://doi.org/10.1007/s00330-016-4468-2

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