Title: Myocardial Delayed Enhancement by Computed Tomography in Hypertrophic Cardiomyopathy
Abstract: HomeCirculationVol. 115, No. 17Myocardial Delayed Enhancement by Computed Tomography in Hypertrophic Cardiomyopathy Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBMyocardial Delayed Enhancement by Computed Tomography in Hypertrophic Cardiomyopathy Afonso Akio Shiozaki, MD, Tiago Senra Garcia Santos, MD, Edmundo Artega, MD, PhD and Carlos Eduardo Rochitte, MD, PhD Afonso Akio ShiozakiAfonso Akio Shiozaki From the Cardiovascular Magnetic Resonance and Computed Tomography Sector of Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. , Tiago Senra Garcia SantosTiago Senra Garcia Santos From the Cardiovascular Magnetic Resonance and Computed Tomography Sector of Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. , Edmundo ArtegaEdmundo Artega From the Cardiovascular Magnetic Resonance and Computed Tomography Sector of Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. and Carlos Eduardo RochitteCarlos Eduardo Rochitte From the Cardiovascular Magnetic Resonance and Computed Tomography Sector of Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. Originally published1 May 2007https://doi.org/10.1161/CIRCULATIONAHA.106.674911Circulation. 2007;115:e430–e431A 35-year-old woman with a previous diagnosis of hypertrophic cardiomyopathy (HCM) was admitted to the Heart Institute of the University of São Paulo Medical School for recurrent palpitation and syncope. The patient had 2 brothers who already had been diagnosed with HCM, and her mother had died suddenly at the age of 38.ECG revealed sinus-rhythm and left–bundle branch block. A tilt-table test was negative, and 24-hour Holter monitoring showed one isolated episode of nonsustained ventricular tachycardia with 3 beatings.Echocardiography revealed hypertrophy of the septal (24 mm) and inferior walls (Movie I), with a maximum systolic gradient of 77 mm Hg. Left ventricular ejection fraction was estimated at 72%, and mass index was estimated at 268 g/m.2Left ventricular hypertrophy was confirmed by cardiovascular magnetic resonance (CMR) and a 30-mm septum thickness was noted (Figure, A and D, and Movie II). Left ventricular ejection fraction was calculated (Simpson) at 77%, and mass index was calculated at 164 g/m2. Delayed enhancement by CMR demonstrated multiple foci of myocardial fibrosis, particularly in the septum and in its junctions with the right ventricular free wall, which has been correlated with the prevalence of risk factors for sudden death1 in HCM patients. Download figureDownload PowerPointCMR and multidetector computed tomography in a patient with hypertrophic cardiomyopathy. A and D, Steady-state free precession (SSFP) with asymmetrical septal and inferior hypertrophy in 2-chamber long-axis (A) and short-axis (D) views by CMR. B and E, Multiple foci of delayed enhancement (myocardial fibrosis) by CMR (arrows), identically reproduced in location and geometry by delayed-enhancement multidetector computed tomography (arrows, C and F).The patient was then submitted to cardiac multidetector computed tomography (Aquilion 64, Toshiba Inc., Japan) 10 minutes after injection of 150 mL of iodine contrast (Iopamiron 370, Shering AG, Germany). Images by multidetector computed tomography showed multiple areas of delayed enhancement in the septum that precisely matched the CMR delayed-enhancement findings (Figure, B, C, E, and F).On the basis of the overall risk factors and test results, the patient received an implantable cardioverter–defibrillator.Recently, myocardial fibrosis has been identified in ischemic patients by multidetector computed tomography, demonstrating infarcted areas similarly to CMR.2,3To our knowledge, this is the first demonstration of myocardial fibrosis by multidetector computed tomography in HCM patients. Such findings may be useful in the evaluation of HCM patients with contraindications for CMR (eg, pacemakers, implantable cardioverter–defibrillators, and claustrophobia).The online-only Data Supplement, consisting of Movies I and II, is available with this article at http://circ.ahajournals.org/cgi/content/full/115/17/e430/DC1.DisclosuresNone.FootnotesCorrespondence to Carlos E. Rochitte, MD, PhD, Instituto do Coração, InCor, Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular, Av. Dr. Enéas de Carvalho Aguiar, 44, Cerqueira César, São Paulo, SP Brazil 05403–000. E-mail [email protected]References1 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.CrossrefMedlineGoogle Scholar2 Gerber BL, Belge B, Legros GJ, Lim P, Poncelet A, Pasquet A, Gisellu G, Coche E, Vanoverschelde JLJ. Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance. Circulation. 2006; 113: 823–833.LinkGoogle Scholar3 Lardo AC, Cordeiro MAS, Silva C, Amado LC, George RT, Saliaris AP, Schuleri KH, Fernandes VR, Zviman M, Nazarian S, Halperin HR, Wu KC, M. Hare JM, Lima JAC. Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation. 2006; 113: 394–404.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Graham-Brown M, Patel A, Stensel D, March D, Marsh A, McAdam J, McCann G and Burton J (2017) Imaging of Myocardial Fibrosis in Patients with End-Stage Renal Disease: Current Limitations and Future Possibilities, BioMed Research International, 10.1155/2017/5453606, 2017, (1-14), . Weissler-Snir A, Crean A and Rakowski H (2015) The role of imaging in the diagnosis and management of hypertrophic cardiomyopathy, Expert Review of Cardiovascular Therapy, 10.1586/14779072.2016.1113130, 14:1, (51-74), Online publication date: 2-Jan-2016. Sukhbir R, Alreshq R and Child N (2015) Imaging in Deciphering Histological Substrates in Hypertrophic Cardiomyopathy, Current Cardiovascular Imaging Reports, 10.1007/s12410-015-9355-8, 8:10, Online publication date: 1-Oct-2015. Mazur W, Siegel M, Miszalski-Jamka T and Pelberg R (2013) Hypertrophic Cardiomyopathy CT Atlas of Adult Congenital Heart Disease, 10.1007/978-1-4471-5088-6_10, (83-88), . Shiozaki A, Senra T, Arteaga E, Martinelli Filho M, Pita C, Ávila L, Parga Filho J, Mady C, Kalil-Filho R, Bluemke D and Rochitte C (2013) Myocardial fibrosis detected by cardiac CT predicts ventricular fibrillation/ventricular tachycardia events in patients with hypertrophic cardiomyopathy, Journal of Cardiovascular Computed Tomography, 10.1016/j.jcct.2013.04.002, 7:3, (173-181), Online publication date: 1-May-2013. Shinbane J, Girsky M, Saxon L, Cao M, Cesario D and Budoff M (2010) CT Imaging: Cardiac Electrophysiology Applications Cardiac CT Imaging, 10.1007/978-1-84882-650-2_22, (293-308), . Shinbane J (2008) CCT Imaging: Cardiac Electrophysiology Applications Handbook of Cardiovascular CT, 10.1007/978-1-84800-091-9_11, (1-13), . May 1, 2007Vol 115, Issue 17 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.674911PMID: 17470702 Originally publishedMay 1, 2007 PDF download Advertisement SubjectsCardiomyopathyComputerized Tomography (CT)Hypertrophy