J Korean Soc Radiol.  2015 Jul;73(1):1-10. 10.3348/jksr.2015.73.1.1.

Coexistent Coronary Artery Disease or Myocardial Bridging in Patients with Hypertrophic Cardiomyopathy Using Coronary CT Angiography

• Lee JH
• Chun EJ
• Kim YK
• Yoo JY
• Choi SI
• Choi DJ

• KMID: 1823916
• DOI: http://doi.org/10.3348/jksr.2015.73.1.1

Abstract

PURPOSE
To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA.
MATERIALS AND METHODS
The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD.
RESULTS
The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively.
CONCLUSION
One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM.

MeSH Terms

Angiography*
Cardiomyopathy, Hypertrophic*
Chest Pain
Coronary Angiography
Coronary Artery Disease*
Coronary Vessels
Echocardiography
Electrocardiography
Humans
Hypertension
Male
Myocardial Bridging*
Phenobarbital
Prevalence
Phenobarbital

Figure

• 

  Fig. 1 A 66-year-old male with hypertrophic cardiomyopathy. A. Serial short axis reformatted images of multidetector-row CT (MDCT) images show ventricular hypertrophy at midventricular anteroseptal wall (dashed arrows). Note the calcified plaque at mid left anterior descending artery (LAD, arrow). B. 2-chamber view demonstrates significant stenosis at proximal to mid LAD (arrow) with mixed plaques. C. Invasive angiography shows significant stenosis (arrow) at proximal LAD which corresponded area on MDCT.

• 

  Fig. 2 A 55-year-old male with hypertrophic cardiomyopathy. A. Serial short axis multidetector-row CT images show full encasement of mid left anterior descending artery (LAD, arrows) within hypertrophied midventricular anteroseptal wall (dashed arrows). B. Invasive angiography demonstrates milking effect with systolic compression of LAD (arrows).

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