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. 2025 Dec;57(1):2533425.
doi: 10.1080/07853890.2025.2533425. Epub 2025 Jul 23.

Association between cardiac dysfunction and late gadolinium enhancement confined to the LV intramural region in patients with hypertrophic cardiomyopathy

Zhi Yang  1 , Feng-You Yao  2 , Yi-Tian Long  1 , Xue Meng  1 , Liang-Chao Gao  1 , Yi You  1 , Miao Wen  1 , Shu-Yue Pan  3
Affiliations

Association between cardiac dysfunction and late gadolinium enhancement confined to the LV intramural region in patients with hypertrophic cardiomyopathy

Zhi Yang et al. Ann Med. 2025 Dec.

Abstract

Aim/introduction: There are two major distributions of late gadolinium enhancement (LGE) in the context of hypertrophic cardiomyopathy (HCM): intramural LGE and LGE at right ventricular insertion points (RVIPs). However, the clinical significance of intramural LGE has not been well established.

Materials and methods: A total of 117 consecutive patients with HCM (61 male; median age, 58.8 years) confirmed by cardiovascular magnetic resonance (CMR) were enrolled, and classified into three groups: (1) no LGE (n = 48), (2) intramural LGE (n = 49), and (3) RVIP LGE (n = 20).

Results: Intramural LGE was detected in 41% of patients with HCM. HCM patients with intramural LGE had greater left ventricular (LV) wall thickness (LVWT) and greater LV mass than those without LGE (all p < 0.05). Furthermore, HCM patients with intramural LGE had a more depressed LV ejection fraction (LVEF) and more impaired global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS) than did those with RVIP LGE and those without LGE (all p < 0.05). Multivariate logistic regression analysis revealed that young age and severely thickened LVWT were associated with intramural LGE in patients with HCM (all p < 0.05). Furthermore, negative correlations were observed between intramural LGE and GRS, GCS, and GLS (all p < 0.001).

Conclusions: Intramural LGE is associated with more severe HCM phenotypes, including a greater LVWT, LV mass and extent of LGE; a reduced LVEF; and impaired myocardial strain. These findings indicate that intramural LGE may be a noninvasive biomarker for risk stratification in patients with HCM.

Keywords: Cardiac magnetic resonance imaging; hypertrophic cardiomyopathy; late gadolinium enhancement; strain.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Late gadolinium enhancement (LGE) patterns for each group. Representative short-axis LGE images of HCM patients showing LGE located at right ventricle insertion points (RVIP LGE) only (B and D, white arrows) and patients with intramural LGE (C and D, yellow arrows). The figure in the bottom right corner shows a patient without LGE (A).
Figure 2.
Figure 2.
Differences in global radial strain (A, %), global circumferential strain (B, %) and global longitudinal strain (C, %) in HCM patients without late gadolinium enhancement (LGE), those with intramural LGE and those with LGE located in the right ventricle insertion points (RVIP LGE) only. **p < 0.01, ***p < 0.001, ****p < 0.0001.
See this image and copyright information in PMC

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