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Role of echocardiography and cardiac MRI in depicting morphological and functional imaging findings useful for diagnosing hypertrophic cardiomyopathy

Ruolo dell’eco-cardiografia e della cardio-RM nella definizione dei rilievi morfologici e funzionali utili nella diagnosi di cardiomiopatia ipertrofica

  • Cardiac Radiology / Cardioradiologia
  • Published:
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Abstract

Purpose

Hypertrophic cardiomyopathy (HCM) is a hereditary disease characterised by primary hypertrophy of the left and/or right ventricle. The reference standard for imaging diagnosis is echocardiography. The aim of our study was to prospectively compare the diagnostic accuracy of echocardiography and cardiac magnetic resonance (MR) imaging in patients with HCM.

Materials and methods

Twenty-two consecutive patients with a known diagnosis of HCM were prospectively evaluated, with echocardiography and cardiac MR imaging performed within 2 weeks of each other (mean interval 7 days, range 2–14 days). Two experienced radiologists blinded to the previous clinical and imaging findings separately reviewed the images. The following parameters were calculated for both techniques: myocardial mass, wall thickness, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), systolic anterior motion (SAM) of the mitral valve and degree of myocardial fibrosis (based on the ultrasonic reflectivity at echocardiography and degree of late enhancement at cardiac MR imaging). The statistical correlation was calculated with Student’s t test, Spearman coefficient and Fisher’s exact test. A value of p<0.05 was considered significant.

Results

The diagnosis of HCM was confirmed in all patients with both techniques, with absolute agreement in terms of the site of disease. The mean value of myocardial mass presented a statistically significant difference between the two techniques (114 g, p<0.001). In contrast, a nonsignificant difference between echocardiography and cardiac MR imaging was found for EDV (102 ml vs 111 ml; p=0.31), ESV (30 ml vs 38 ml; p=0.1), EF (74% vs 68%, p=0.5), SAM (p=0.1) and myocardial fibrosis (p=0.15).

Conclusions

Cardiac MR imaging correlates well with echocardiography in defining the morphological and functional parameters useful for the imaging diagnosis of HCM and therefore, in selected cases (poor acoustic window, doubtful echocardiography findings), it may be a valid alternative to echocardiography.

Riassunto

Obiettivo

La cardiomiopatia ipertrofica (CMI) è una malattia ereditaria caratterizzata dalla primitiva ipertrofia del ventricolo sinistro e/o destro. Lo standard di riferimento per la diagnosi strumentale è rappresentato dall’eco-cardiografia. Il nostro scopo è confrontare prospetticamente l’accuratezza diagnostica di ecocardiografia e risonanza magnetica cardiaca (cardio-RM) in pazienti con CMI.

Materiali e metodi

Ventidue pazienti consecutivi con diagnosi nota di CMI sono stati prospetticamente valutati mediante eco-cardiografia e cardio-RM eseguite entro 2 settimane (scarto medio 7 giorni, range 2–14 giorni). Due operatori esperti, non a conoscenza dei precedenti dati clinici e strumentali dei pazienti arruolati, hanno revisionato separatamente le immagini. Per entrambe le tecniche sono stati calcolati massa cardiaca, spessori di parete, volume telediastolico (VTD) e telesistolico (VTS), frazione di eiezione (FE), spostamento anteriore del lembo mitralico (SAM), grado di fibrosi parietale (basato sul valore di eco-rinfrangenza all’eco-cardiografia e sull’entità di impregnazione tardiva alla cardio-RM). La correlazione statistica è stata calcolata mediante test t di Student, R di Spearman e test di Fisher. Un valore di p<0,05 è stato considerato significativo.

Risultati

La diagnosi di CMI è stata confermata in tutti i pazienti con entrambe le metodiche, con concordanza assoluta per quanto riguarda la sede. Il valore medio della massa cardiaca ha presentato una differenza statisticamente significativa tra le due metodiche (114 g, p<0,001). Al contrario, una differenza non significativa fra eco-cardiografia e cardio-RM è stata riscontrata per i valori di VTD (102 ml vs 111 ml; p=0,31), VTS (30 ml vs 38 ml; p=0,1), frazione d’eiezione (74% vs 68%, p=0,5), SAM (p=0,1), fibrosi parietale (p=0,15).

Conclusioni

La cardio-RM correla bene con l’ecocardiografia nella definizione dei parametri morfologici e funzionali utili per la diagnosi strumentale di CMI e può pertanto rappresentare, in casi selezionati (scarsa finestra acustica, rilievi eco-cardiografici dubbi), una valida alternativa all’eco-cardiografia.

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Authors and Affiliations

  1. Radiologia, Ospedale San Bassiano, Via dei Lotti 61, 36060, Bassano del Grappa, Italy

    A. Guarise

  2. Istituto di Radiologia, Policlinico G.B. Rossi, Università di Verona, Verona, Italy

    N. Faccioli & G. Foti

  3. Radiologia, Ospedale Misericordia, Grosseto, Italy

    S. Da Pozzo

  4. Cardiologia, Ospedale Cà Foncello Treviso, Treviso, Italy

    P. Meneghetti

  5. Radiologia Clinica, Ospedale Cà Foncello Treviso, Treviso, Italy

    G. Morana

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  1. A. Guarise
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  2. N. Faccioli
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  3. G. Foti
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  4. S. Da Pozzo
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  5. P. Meneghetti
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Correspondence to A. Guarise.

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Guarise, A., Faccioli, N., Foti, G. et al. Role of echocardiography and cardiac MRI in depicting morphological and functional imaging findings useful for diagnosing hypertrophic cardiomyopathy. Radiol med 116, 197–210 (2011). https://doi.org/10.1007/s11547-010-0603-3

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  • DOI: https://doi.org/10.1007/s11547-010-0603-3

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