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. 2024 Apr 9;24(1):203.
doi: 10.1186/s12872-024-03859-2.

Focal ischemic myocardial fibrosis assessed by late gadolinium enhancement cardiovascular magnetic resonance in patients with hypertrophic cardiomyopathy

Yang Zhi #  1 , Fu-Dan Gui #  2 , Meng Xue  1 , Yi-Tian Long  1 , Wen Miao  1 , You Yi  1 , Liang-Chao Gao  3 , Fu Bing #  4 , Shu-Yue Pan #  5
Affiliations

Focal ischemic myocardial fibrosis assessed by late gadolinium enhancement cardiovascular magnetic resonance in patients with hypertrophic cardiomyopathy

Yang Zhi et al. BMC Cardiovasc Disord. .

Abstract

Background: In patients with hypertrophic cardiomyopathy (HCM), ischemic myocardial fibrosis assessed by late gadolinium enhancement (I-LGE) using cardiovascular magnetic resonance (CMR) have been reported. However, the clinical significance of I-LGE has not been completely understood. We aim to evaluate the I-LGE differ phenotypically from HCM without LGE or nonischemic myocardial fibrosis assessed by late gadolinium enhancement (NI-LGE) in the left ventricle (LV).

Methods: The patients with HCM whom was underwent CMR were enrolled, using cine cardiac magnetic resonance to evaluate LV function and LGE to detect the myocardial fibrosis. Three groups were assorted: 1) HCM without LGE; 2) HCM with LGE involved the subendocardial layer was defined as I-LGE; 3) HCM with LGE not involved the subendocardial layer was defined as NI-LGE.

Results: We enrolled 122 patients with HCM in the present study. LGE was detected in 58 of 122 (48%) patients with HCM, and 22 (18%) of patients reported I-LGE. HCM with I-LGE had increased higher left ventricular mass index (LVMI) (P < 0.0001) than HCM with NI-LGE or without LGE. In addition, HCM with I-LGE had a larger LV end- systolic volume (P = 0.045), lower LV ejection fraction (LVEF) (P = 0.026), higher LV myocardial mass (P < 0.001) and thicker LV wall (P < 0.001) more than HCM without LGE alone. The I-LGE were significantly associated with LVEF (OR: 0.961; P = 0.016), LV mass (OR: 1.028; P < 0.001), and maximal end-diastolic LVWT (OR: 1.567; P < 0.001). On multivariate analysis, LVEF (OR: 0.948; P = 0.013) and maximal end-diastolic LVWT (OR: 1.548; P = 0.001) were associated with higher risk for I-LGE compared to HCM without LGE. Noticeably, the maximal end-diastolic LVWT (OR: 1.316; P = 0.011) was the only associated with NI-LGE compared to HCM without LGE.

Conclusions: I-LGE is not uncommon in patients with HCM. HCM with I-LGE was associated with significant LV hypertrophy, extensive LGE and poor LV ejection fraction. We should consider focal ischemic myocardial fibrosis when applying LGE to risk stratification for HCM.

Keywords: Cardiac magnetic resonance imaging; Fibrosis; Hypertrophic cardiomyopathy; Late gadolinium enhancement.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Examples of focal myocardial fibrosis in patients with HCM. The case shows an HCM patient without LGE (A). CMR images of patients with nonischemic myocardial fibrosis (red arrow) detected by LGE (B). The case showed the presence of LGE and involved the subendocardial layer (blue arrow), which was defined as ischemic myocardial fibrosis (C). LGE, late gadolinium enhancement
See this image and copyright information in PMC

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