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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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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DOI: https://doi.org/10.1007/s00330-016-4468-2