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Structural abnormalities in hypertrophic cardiomyopathy beyond left ventricular hypertrophy by multimodality imaging evaluation
Author(s) -
UrbanoMoral Jose Angel,
GutierrezGarciaMoreno Laura,
RodriguezPalomares Jose Fernando,
MatabuenaGomezLimon Javier,
Niella Natalia,
Maldonado Giuliana,
ValleRacero Juan Ignacio,
Niella Marcela,
TeixidoTura Gisela,
GarciaDorado David,
Ferrazzi Paolo,
Pandian Natesa G.,
EvangelistaMasip Arturo
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14393
Subject(s) - hypertrophic cardiomyopathy , medicine , papillary muscle , cardiology , muscle hypertrophy , magnetic resonance imaging , mitral valve , left ventricular hypertrophy , cardiomyopathy , cardiac magnetic resonance imaging , basal (medicine) , population , radiology , heart failure , environmental health , blood pressure , insulin
Background Echocardiography‐ and cardiovascular magnetic resonance (CMR)‐based studies have revealed a wide range of phenotypic manifestations in hypertrophic cardiomyopathy (HCM) apart from hypertrophy. This study sought to comprehensively describe a number of structural abnormalities in HCM beyond hypertrophy, by multimodality imaging. Methods A total of 100 HCM patients were prospectively enrolled, undergoing standard and contrast echocardiography, and CMR. Morphological characteristics involving mitral valve leaflets (MVL), subvalvular apparatus, and left ventricular cavity and wall were investigated. Seventy healthy volunteers served as control population. Results As assessed by echo, MVLs were longer in HCM patients than in controls (anterior method 1: 24[22,28] vs 19[18,20] mm, P < 0.01; anterior method 2: 27[24, 29] vs 21[19, 23] mm, P < 0.01; posterior: 15[12,19] vs 14[13,15] mm, P < 0.01). Abnormal chordal attachment to anterior MVL, anterior papillary muscle displacement, and accessory apical‐basal muscle bundle were present in 42 (42%), 61 (61%), and 35 (35%) patients, respectively ( P values vs controls <0.01); direct papillary muscle insertion into MVL and hypertrabeculation were found in two and five patients, respectively. Contrast echocardiography (n = 94) detected myocardial crypts in 15 patients (16%). Overall, 83% of HCM subjects had at least one of these phenotypic manifestations. Echocardiography and CMR agreement for MVL length was poor, while for structural characteristics was moderate to substantial (Cohen's Kappa : 0.53‐1.00). Except for posterior MVL length and hypertrabeculation, the phenotypic characteristics studied had acceptable reproducibility by echocardiography and CMR. Conclusions Structural abnormalities in HCM beyond hypertrophy are significantly common. Multimodality imaging approach to these HCM facets by echocardiography and CMR is feasible and desirable.