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Cardiac computed tomographic imaging to evaluate myocardial scarring/fibrosis in patients with hypertrophic cardiomyopathy: a comparison with cardiac magnetic resonance imaging

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Abstract

Contrast enhanced magnetic resonance imaging (CeMRI) reliably identifies myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM). However, many patients have contraindications to ceMRI. Previous studies have shown that contrast enhanced multi-detector computed tomography (ceMDCT) can visualize focal scars following myocardial infarction in experimental animals and patients. The purpose of this manuscript is to assess the ability of ceMDCT to detect focal myocardial scars in patients with HCM. Twelve HCM patients underwent ceMRI and ceMDCT. Fibrotic areas of myocardium were defined as focal or diffuse areas of fibrosis. The mean signal intensity in ceMRI and attenuation values in ceMDCT of the fibrotic regions, normal myocardium and left ventricle blood pool contrast were measured using qualitative and quantitative analysis. Focal scar mass was calculated using both techniques. Focal scars were detected in 9 patients and diffuse fibrosis was visualized in all patients by ceMRI. Differences between normalized SI of normal myocardium and focal scars, normal and diffuse areas of fibrosis, and diffuse fibrosis and focal scars were significant for both ceMRI and ceMDCT (p < 0.05). Diffuse fibrosis was poorly visualized by ceMDCT but was detectable using quantitative measurements. CeMDCT has potential to detect focal myocardial scars in patients with HCM who have contraindications to ceMRI study. However, ceMDCT does not enable adequate visualization of diffuse myocardial fibrosis, and thus is less well suited than ceMRI for assessment of total burden of fibrosis. This limitation may be overcome using quantitative methodology.

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References

  1. Spirito P, Seidman CE, McKenna WJ et al (1997) The management of hypertrophic cardiomyopathy. N Engl J Med 336:775–785

    Article  PubMed  CAS  Google Scholar 

  2. Maron BJ, McKenna WJ, Danielson GK et al (2003) American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American college of cardiology foundation task force on clinical expert consensus documents and the European society of cardiology committee for practice guidelines. J Am Coll Cardiol 42:1687–1713

    Article  PubMed  Google Scholar 

  3. Maron BJ (2002) Cardiology patient pages. Hypertrophic cardiomyopathy. Circulation 106:2419–2421

    Article  PubMed  Google Scholar 

  4. Choudhury L, Mahrholdt H, Wagner A et al (2002) Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 40:2156–2164

    Article  PubMed  Google Scholar 

  5. Adabag AS, Maron BJ, Appelbaum E et al (2008) Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol 51:1369–1374

    Article  PubMed  Google Scholar 

  6. Varnava AM, Elliott PM, Mahon N et al (2001) Relation between myocyte disarray and outcome in hypertrophic cardiomyopathy. Am J Cardiol 88:275–279

    Article  PubMed  CAS  Google Scholar 

  7. Maron BJ (1997) Hypertrophic cardiomyopathy. Lancet 350:127–133

    Article  PubMed  CAS  Google Scholar 

  8. Lima JA, Judd RM, Bazille A et al (1995) Regional heterogeneity of human myocardial infarcts demonstrated by contrast-enhanced MRI. Potential mechanisms. Circulation 92:1117–1125

    Article  PubMed  CAS  Google Scholar 

  9. Moon JC, Sievers B, Pennell DJ et al (2003) Myocardial scarring caused by left ventricular assist device (LVAD) insertion demonstrated by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 5:361–363

    Article  PubMed  Google Scholar 

  10. Gerber BL, Belge B, Legros GJ et al (2006) Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance. Circulation 113:823–833

    Article  PubMed  Google Scholar 

  11. Baks T, Cademartiri F, Moelker AD et al (2006) Multislice computed tomography and magnetic resonance imaging for the assessment of reperfused acute myocardial infarction. J Am Coll Cardiol 48:144–152

    Article  PubMed  Google Scholar 

  12. Mahnken AH, Katoh M, Bruners P et al (2005) Acute myocardial infarction: assessment of left ventricular function with 16-detector row spiral CT versus MR imaging—study in pigs. Radiology 236:112–117

    Article  PubMed  Google Scholar 

  13. Christner JA, Kofler JM, McCollough CH (2010) Estimating effective dose for CT using dose-length product compared with using organ doses: consequences of adopting International Commission on Radiological Protection publication 103 or dual-energy scanning. AJR Am J Roentgenol 194:881–889

    Article  PubMed  Google Scholar 

  14. Moon JC, McKenna WJ, McCrohon JA et al (2003) Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol 41:1561–1567

    Article  PubMed  Google Scholar 

  15. Sandstede J, Lipke C, Beer M et al (2000) Age- and gender-specific differences in left and right ventricular cardiac function and mass determined by cine magnetic resonance imaging. Eur Radiol 10:438–442

    Article  PubMed  CAS  Google Scholar 

  16. Simor T, Suranyi P, Ruzsics B et al (2010) Percent infarct mapping for delayed contrast enhancement magnetic resonance imaging to quantify myocardial viability by Gd(DTPA). J Magn Reson Imaging 32:859–868

    Article  PubMed  Google Scholar 

  17. Krombach GA, Niendorf T, Gunther RW et al (2007) Characterization of myocardial viability using MR and CT imaging. Eur Radiol 17:1433–1444

    Article  PubMed  Google Scholar 

  18. Saito H, Naito H, Takamiya M et al (1991) Late enhancement of the left ventricular wall in hypertrophic cardiomyopathy by ultrafast computed tomography: a comparison with regional myocardial thickening. Br J Radiol 64:993–1000

    Article  PubMed  CAS  Google Scholar 

  19. Maron MS, Appelbaum E, Harrigan CJ et al (2008) Clinical profile and significance of delayed enhancement in hypertrophic cardiomyopathy. Circ Heart Fail 1:184–191

    Article  PubMed  Google Scholar 

  20. Shiozaki AA, Kim RJ, Parga JR et al (2007) Cardiovascular magnetic resonance in hypertrophic cardiomyopathy. Arq Bras Cardiol 88:243–248

    Article  PubMed  Google Scholar 

  21. Yan AT, Shayne AJ, Brown KA et al (2006) Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation 114:32–39

    Article  PubMed  Google Scholar 

  22. Roes SD, Borleffs CJ, van der Geest RJ et al (2009) Infarct tissue heterogeneity assessed with contrast-enhanced MRI predicts spontaneous ventricular arrhythmia in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillator. Circ Cardiovasc Imaging 2:183–190

    Article  PubMed  Google Scholar 

  23. Kwon DH, Smedira NG, Rodriguez ER et al (2009) Cardiac magnetic resonance detection of myocardial scarring in hypertrophic cardiomyopathy: correlation with histopathology and prevalence of ventricular tachycardia. J Am Coll Cardiol 54:242–249

    Article  PubMed  Google Scholar 

  24. O’Hanlon R, Grasso A, Roughton M et al (2010) Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol 56:867–874

    Article  PubMed  Google Scholar 

  25. Bruder O, Wagner A, Jensen CJ et al (2010) Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 56:875–887

    Article  PubMed  Google Scholar 

  26. Iles L, Pfluger H, Phrommintikul A et al (2008) Evaluation of diffuse myocardial fibrosis in heart failure with cardiac magnetic resonance contrast-enhanced T1 mapping. J Am Coll Cardiol 52:1574–1580

    Article  PubMed  Google Scholar 

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Conflict of interest

All the authors of the manuscript (Jennifer I. Berliner MD, FACC, Aya Kino MD, James C. Carr, MD, Robert O. Bonow, MD,MACC, Lubna Choudhury, MB BCh, MD, MRCP, FACC) does not have nothing to disclosure and have full control of all primary data and also allow the journal to review the data if requested.

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Authors and Affiliations

  1. Department of Medicine and Feinberg School of Medicine, Division of Cardiology, Northwestern University, 676 North St Clair Street, Suite 600, Chicago, IL, 60611, USA

    Lubna Choudhury

  2. Department of Medicine and Feinberg School of Medicine, Center for Cardiovascular Innovation, Northwestern University, 645 N Michigan Ave suite 1006, Chicago, IL, 60611, USA

    Robert O. Bonow

  3. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Aya Kino & James C. Carr

  4. Department of Medicine Veterans Affairs Pittsburgh Healthcare System, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Jennifer I. Berliner

Authors
  1. Jennifer I. Berliner
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  2. Aya Kino
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  3. James C. Carr
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  4. Robert O. Bonow
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  5. Lubna Choudhury
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Corresponding author

Correspondence to Lubna Choudhury.

Additional information

Jennifer I. Berliner and Aya Kino contributed equally to this article.

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Berliner, J.I., Kino, A., Carr, J.C. et al. Cardiac computed tomographic imaging to evaluate myocardial scarring/fibrosis in patients with hypertrophic cardiomyopathy: a comparison with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 29, 191–197 (2013). https://doi.org/10.1007/s10554-012-0048-y

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  • DOI: https://doi.org/10.1007/s10554-012-0048-y

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