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Left ventricular function in patients with hypertrophic cardiomyopathy and its relation to myocardial fibrosis and exercise tolerance

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Abstract

We sought to determine the relation between myocardial extracellular volume (ECV), left ventricular (LV) diastolic function, and exercise tolerance in patients with hypertrophic cardiomyopathy (HCM). Forty five HCM patients with an ejection fraction >50% and no previous septal reduction therapy underwent imaging by CMR and transthoracic echocardiography. CMR was used to quantify LV volumes, mass, EF, LA volumes, scar burden, pre and post contrast T1 relaxation times and ECV. Echocardiography was used to measure outflow tract gradients, mitral inflow and annular velocities, circumferential strain, systolic, early and late diastolic strain rates. Exercise duration and peak oxygen consumption were noted. HCM patients had increased native T1 relaxation time and ECV vs. controls [ECV controls: 24.7 (23.2–26.4) vs. HCM: 26.8 (24.6–31.3)%, P = 0.014]. Both parameters were significantly associated with LV diastolic dysfunction, circumferential strain, diastolic strain rate and peak oxygen consumption (r = −0.73, P < 0.001). Compared to controls, HCM patients have significantly longer native T1 relaxation time and higher ECV. These structural changes lead to worse LV global and segmental diastolic function and in turn reduced exercise tolerance.

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Authors and Affiliations

  1. Methodist DeBakey Heart and Vascular Center, and Cardiovascular Imaging Institute, The Methodist Hospital, 6550 Fannin, SM-677, Houston, TX, 77030, USA

    Paulino A. Alvarez, Mohamad G. Ghosn, Karen Chin, Jeremy J. Hinojosa, John M. Buergler, Dipan J. Shah & Sherif F. Nagueh

  2. Cardiovascular Imaging Section, 401 General Army Hospital of Athens, Athens, Greece

    Dimitrios Maragiannis

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  1. Dimitrios Maragiannis
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  2. Paulino A. Alvarez
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  3. Mohamad G. Ghosn
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Correspondence to Sherif F. Nagueh.

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Maragiannis, D., Alvarez, P.A., Ghosn, M.G. et al. Left ventricular function in patients with hypertrophic cardiomyopathy and its relation to myocardial fibrosis and exercise tolerance. Int J Cardiovasc Imaging 34, 121–129 (2018). https://doi.org/10.1007/s10554-017-1214-z

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