J Cardiovasc Ultrasound.  2016 Sep;24(3):239-242. 10.4250/jcu.2016.24.3.239.

Findings of Cardiac Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy after 16 Years

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. anthleemd@naver.com

Abstract

A 58-year-old man had been diagnosed with non-obstructive hypertrophic cardiomyopathy (HCMP) according to echocardiography findings 16 years ago. Echocardiography showed ischemic cardiomyopathy (CMP)-like features with decreased systolic function but a non-dilated chamber. Coronary angiography was performed but showed a normal coronary artery. Cardiac magnetic resonance imaging (MRI) revealed multifocal transmural and subepicardial delayed-enhancing areas at the anteroseptal, septal, and inferoseptal left ventricular (LV) wall, and wall thinning and decreased motion of the anteroseptal LV wall. Findings of ischemic CMP-like features by echocardiography suggested microvascular dysfunction. This late stage of HCMP carries a high risk of sudden death. Cardiac MRI evaluation may be necessary in cases of ischemic CMP-like features in HCMP. In this case, the diagnosis of end-stage HCMP with microvascular dysfunction was confirmed by using cardiac MRI after a follow-up period of more than 16 years.

Keyword

Hypertrophic cardiomyopathy; Microvascular dysfunction; Cardiac magnetic resonance imaging

MeSH Terms

Cardiomyopathies
Cardiomyopathy, Hypertrophic*
Coronary Angiography
Coronary Vessels
Death, Sudden
Diagnosis
Echocardiography
Follow-Up Studies
Humans
Magnetic Resonance Imaging*
Middle Aged

Figure

  • Fig. 1 After 7 years, transthoracic echocardiography M-mode image (A), four chamber view (C), after 16 years, M-mode image (B), and four chamber view (D).

  • Fig. 2 Delayed enhancement images demonstrating hyperenhancement (arrows) involving the myocardium and epicardium irrespectively territory of coronary artery.


Reference

1. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002; 287:1308–1320.
2. Olivotto I, Maron BJ, Appelbaum E, Harrigan CJ, Salton C, Gibson CM, Udelson JE, O'Donnell C, Lesser JR, Manning WJ, Maron MS. Spectrum and clinical significance of systolic function and myocardial fibrosis assessed by cardiovascular magnetic resonance in hypertrophic cardiomyopathy. Am J Cardiol. 2010; 106:261–267.
3. Harris KM, Spirito P, Maron MS, Zenovich AG, Formisano F, Lesser JR, Mackey-Bojack S, Manning WJ, Udelson JE, Maron BJ. Prevalence, clinical profile, and significance of left ventricular remodeling in the end-stage phase of hypertrophic cardiomyopathy. Circulation. 2006; 114:216–225.
4. Klues HG, Schiffers A, Maron BJ. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by two-dimensional echocardiography in 600 patients. J Am Coll Cardiol. 1995; 26:1699–1708.
5. Biagini E, Coccolo F, Ferlito M, Perugini E, Rocchi G, Bacchi-Reggiani L, Lofiego C, Boriani G, Prandstraller D, Picchio FM, Branzi A, Rapezzi C. Dilated-hypokinetic evolution of hypertrophic cardiomyopathy: prevalence, incidence, risk factors, and prognostic implications in pediatric and adult patients. J Am Coll Cardiol. 2005; 46:1543–1550.
6. Maron BJ, Spirito P. Implications of left ventricular remodeling in hypertrophic cardiomyopathy. Am J Cardiol. 1998; 81:1339–1344.
7. Chang KH, Ha JW, Chung NS, Cho SY. Progression of hypertrophic cardiomyopathy to dilated cardiomyopathy--a case reports and review of the literatures. Yonsei Med J. 1998; 39:61–66.
8. Lorenzoni R, Gistri R, Cecchi F, Olivotto I, Chiriatti G, Elliott P, McKenna WJ, Camici PG. Coronary vasodilator reserve is impaired in patients with hypertrophic cardiomyopathy and left ventricular dysfunction. Am Heart J. 1998; 136:972–981.
9. Moon JC, Reed E, Sheppard MN, Elkington AG, Ho SY, Burke M, Petrou M, Pennell DJ. The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2004; 43:2260–2264.
10. Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG. Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. N Engl J Med. 2003; 349:1027–1035.
11. Moon JC, McKenna WJ, McCrohon JA, Elliott PM, Smith GC, Pennell DJ. Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol. 2003; 41:1561–1567.
12. Olivotto I, Maron MS, Autore C, Lesser JR, Rega L, Casolo G, De Santis M, Quarta G, Nistri S, Cecchi F, Salton CJ, Udelson JE, Manning WJ, Maron BJ. Assessment and significance of left ventricular mass by cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2008; 52:559–566.
Full Text Links
  • JCU
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr