Microvascular ischemia in hypertrophic cardiomyopathy: new insights from high-resolution combined quantification of perfusion and late gadolinium enhancement

• Type: Article in International Scientific Journal
• Date: 2016

Authors

Villa, ADM (Author) Other; Sammut, E (Author) Other; Zarinabad, N (Author) Other; Carr White, G (Author) Other; Lee, J (Author) Other; Bettencourt, N (Author) FMUP; Razavi, R (Author) Other; Nagel, E (Author) Other; Chiribiri, A (Author) Other

Journal

The Journal is awaiting validation by the Administrative Services.

Title: JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE

Vol. 18

ISSN: 1097-6647

Indexing

ISI Web of Knowledge - 32 Citations

Scopus - 33 Citations

Other information

Authenticus ID: P-00K-0K8

DOI: 10.1186/s12968-016-0223-8

Abstract (EN): Background: Microvascular ischemia is one of the hallmarks of hypertrophic cardiomyopathy (HCM) and has been associated with poor outcome. However, myocardial fibrosis, seen on cardiovascular magnetic resonance (CMR) as late gadolinium enhancement (LGE), can be responsible for rest perfusion defects in up to 30 % of patients with HCM, potentially leading to an overestimation of the ischemic burden. We investigated the effect of left ventricle (LV) scar on the total LV ischemic burden using novel high-resolution perfusion analysis techniques in conjunction with LGE quantification. Methods: 30 patients with HCM and unobstructed epicardial coronary arteries underwent CMR with Fermi constrained quantitative perfusion analysis on segmental and high-resolution data. The latter were corrected for the presence of fibrosis on a pixel-by-pixel basis. Results: High-resolution quantification proved more sensitive for the detection of microvascular ischemia in comparison to segmental analysis. Areas of LGE were associated with significant reduction of myocardial perfusion reserve (MPR) leading to an overestimation of the total ischemic burden on non-corrected perfusion maps. Using a threshold MPR of 1.5, the presence of LGE caused an overestimation of the ischemic burden of 28 %. The ischemic burden was more severe in patients with fibrosis, also after correction of the perfusion maps, in keeping with more severe disease in this subgroup. Conclusions: LGE is an important confounder in the assessment of the ischemic burden in patients with HCM. High-resolution quantitative analysis with LGE correction enables the independent evaluation of microvascular ischemia and fibrosis and should be used when evaluating patients with HCM.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 11