Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy.
By L. Choudhury, H. Mahrholdt, A. Wagner, Kelly M. Choi, M. Elliott, F. Klocke, R. Bonow, R. Judd, R. Kim. Journal of the American College of Cardiology, 2002
629 citations recorded by the source corpus.
OBJECTIVES We sought to ascertain whether myocardial scarring occurs in living unselected patients with hypertrophic cardiomyopathy (HCM). BACKGROUND Myocardial scarring is known to occur in select HCM patients, who were highly symptomatic prior to death or who died suddenly. The majority of HCM patients, however, are minimally symptomatic and have not suffered sudden death. METHODS Cine and gadolinium-enhanced magnetic resonance imaging was performed in 21 HCM patients who were predominantly asymptomatic. Gadolinium hyperenhancement was assumed to represent myocardial scar, and the extent of scar was compared to left ventricular (LV) morphology and function. RESULTS Scarring was present in 17 patients (81%). Scarring occurred only in hypertrophied regions (> or =10 mm), was patchy with multiple foci, and predominantly involved the middle third of the ventricular wall. All 17 patients had scarring at the junction of the interventricular septum and the right ventricular (RV) free wall. On a regional basis, the extent of scarring correlated positively with wall thickness (r = 0.36, p < 0.0001), and inversely with wall thickening (r = -0.21, p < 0.0001). On a per patient basis, the extent of scarring (mean, 8 +/- 9% of LV mass) was minimally related to maximum wall thickness (r = 0.40, p = 0.07) and LV mass (r = 0.33, p = 0.15), and correlated inversely with ejection fraction (r = -0.46, p = 0.04). CONCLUSIONS Myocardial scarring is common in asymptomatic or mildly symptomatic HCM patients who have not suffered sudden death. When present, scarring occurs in hypertrophied regions, is consistently localized to the junctions of the septum and RV free wall, and correlates positively with regional hypertrophy and inversely with regional contraction.
Subfields: Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and Imaging
View Paper: https://www.semanticscholar.org/paper/bc058ebf07b48f80871edbfe864a05c5e6cbfa02
How researchers see this paper
The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.
In Cardiology and Cardiovascular Medicine
In Radiology, Nuclear Medicine and Imaging
Citations in the corpus
- Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. (2008, neutral): “Syncope, n (%) 36 ( 20 ) 13 (18) 23 (22) 0.53 Medications, n (%)”
- Cardiac autophagy is a maladaptive response to hemodynamic stress. (2007, background): “Intriguingly, myocardial scarring in patients with hypertrophic cardiomyopathy is inhomogeneous, and, when present, consistently localizes to the interventricular septum (40).”
- American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice G (2003, background): “Disease consequences related to chronic outflow gradients are likely to be mediated by the resultant increase in LV wall stress, myocardial ischemia and eventually cell death and replacement fibrosis (7,127,129).”
- The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. (2004, background): “Regions of myocardial late gadolinium enhancement lso occur in hypertrophic cardiomyopathy (HCM) (3), and he extent of enhancement has been associated with clinical arkers of sudden death risk and progression to heart ailure (4).”