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MRT-Bildgebung bei hypertropher Kardiomyopathie (HCM)

Evaluation der diastolischen Funktion

Magnetic resonance imaging of hypertrophic cardiomyopathy

Evaluation of diastolic function

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Zusammenfassung

Die hypertrophe Kardiomyopathie (HCM) hat eine Prävalenz von ca. 0,2% und verläuft in vielen Fällen zeitlebens klinisch asymptomatisch. Falls es zur Ausbildung von Symptomen kommt, sind diese oft unspezifisch. Dies erklärt den Stellenwert der Bildgebung bei der Erstdiagnose und Verlaufsbeurteilung der HCM. Leitbefund ist eine myokardiale Hypertrophie mit Wanddicken von ≥ 15 mm. Während die Echokardiographie ein hervorragendes Screeningverfahren ist, erlaubt die MRT eine umfassende Feindiagnostik bei der HCM, zu der gezählt werden: eine genaue Darstellung des Verteilungsmusters und des Schweregrads der Hypertrophie, eine detaillierte Analyse der linksventrikulären systolischen und diastolischen Funktion, eine Beurteilung und Quantifizierung einer möglichen dynamischen Obstruktion des linksventrikulären Ausflusstrakts sowie einer möglichen verfrühten Öffnung der Mitralklappe (SAM-Phänomen, „systolic anterior motion of the mitral valve“). Zusätzlich können bei Kontrastmittelgabe der Status der myokardialen Perfusion sowie das Vorliegen und der Schweregrad einer myokardialen Fibrose beurteilt werden. Wir haben untersucht, ob sich Patienten mit und ohne globale diastolische Dysfunktion in den systolischen Funktionsparametern oder hinsichtlich der endsystolischen bzw. enddiastolischen Myokarddicke des Septums oder der lateralen Wand unterscheiden.

Abstract

Hypertrophic cardiomyopathy (HCM) has a prevalence of approximately 0.2% and is clinically asymptomatic in many patients or presents with unspecific symptoms. This explains the importance of imaging for the diagnosis of HCM as well as for the assessment of the clinical course. The definitive finding in HCM is myocardial hypertrophy with thickening of the ventricular wall ≥ 15 mm. While echocardiography is an excellent screening tool magnetic resonance imaging (MRI) allows a comprehensive analysis of the heart in HCM. This includes a detailed analysis of the distribution and extent of myocardial hypertrophy, a thorough evaluation of systolic and diastolic cardiac function, the assessment of the presence and extent of dynamic outflow tract obstruction as well as the description of the systolic anterior motion (SAM) phenomenon of the mitral valve with secondary mitral insufficiency. When contrast material is administered, additional information about myocardial perfusion as well as the presence and extent of myocardial fibrosis can be obtained. This study compared systolic functional parameters as well as end systolic and end diastolic wall thickness of patients with and without diastolic dysfunction.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    F. Schwarz, F. Schwab, D. Zinsser, T. Gölz, M.F. Reiser & D. Theisen

  2. Deutsches Zentrum für Herzkreislaufforschung (DZHK), -, -

    F. Schwarz, M.F. Reiser & D. Theisen

  3. Josef Lissner Laboratory for Biomedical Imaging, Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    F. Schwab

  4. Medizinische Klinik und Poliklinik I, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    B.M. Beckmann, F. Schuessler & S. Kääb

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  1. F. Schwarz
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Correspondence to F. Schwarz.

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Schwarz, F., Schwab, F., Beckmann, B. et al. MRT-Bildgebung bei hypertropher Kardiomyopathie (HCM). Radiologe 53, 15–23 (2013). https://doi.org/10.1007/s00117-012-2381-5

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  • DOI: https://doi.org/10.1007/s00117-012-2381-5

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