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Early gadolinium enhancement in hypertrophic cardiomyopathy: a potential premature marker of myocardial damage

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Abstract

Early gadolinium enhancement (EGE), one CMR diagnostic criteria in acute myocarditis, has been related with hyperemia and capillary leakage. The value of EGE in hypertrophic cardiomyopathy (HCM) remains unknown. Our aim was to determine the prevalence of EGE in patients with HCM, and its relation with late gadolinium enhancement (LGE). The association of EGE with morphological and clinical parameters was also evaluated. Sixty consecutive patients with HCM and CMR from our center were included. All the clinical and complementary test information was collected prospectively in our HCM clinic. Left ventricular (LV) measurements were calculated from cine sequences. EGE and LGE were quantified with a dedicated software. Clinical events were collected from medical records. A slow wash-out pattern on EGE was detected in up to 68 % of the patients, being an isolated finding without LGE in 10 (16 %). This cohort showed a greater maximal LV wall thickness (20.1 ± 4 vs. 18.1 ± 3.5 mm, p = 0.010) and asymmetry ratio (1.86 ± 0.42 vs. 1.62 ± 0.46; p = 0.039). The percentage of EGE/slice and the difference with the percentage LGE/slice demonstrated a significant positive correlation with the maximal LV wall thickness (Rho 0.450 and 0.386 respectively). EGE also correlated with number of segments with LVH (LV hypertrophy) and the asymmetry ratio. Neither EGE nor LGE were associated with classical risk factors, the risk score for sudden cardiac death, or with major clinical events. EGE was a frequent finding in HCM, even in absence of LGE. This phenomenon showed a positive correlation with morphological markers of disease burden.

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Acknowledgments

This work was partially supported by Spanish Society of Cardiology through a grant for the project “Utility of new morphological and tissue characterization patterns determined by cardiac magnetic resonance in the prognostic evaluation of patients with hypertrophic cardiomyopathy” (“Utilidad de nuevos patrones morfológicos y de caracterización tisular medidos por resonancia magnética cardiaca en la valoración pronóstica de los pacientes con miocardiopatia hipertrófica”).

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    Authors and Affiliations

    1. Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Calle de Diego León, 62, 28006, Madrid, Spain

      Eduardo Pozo, Dafne Viliani, Norma Aguirre, Pilar Agudo-Quilez, Luis Jesús Jiménez-Borreguero & Fernando Alfonso

    2. Radiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain

      María José Olivera & Paloma Caballero

    3. Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain

      Luis Jesús Jiménez-Borreguero

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    1. Eduardo Pozo
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    Eduardo Pozo and Dafne Viliani have contributed equally to this study.

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    Pozo, E., Viliani, D., Aguirre, N. et al. Early gadolinium enhancement in hypertrophic cardiomyopathy: a potential premature marker of myocardial damage. Int J Cardiovasc Imaging 32, 1635–1643 (2016). https://doi.org/10.1007/s10554-016-0954-5

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