Data_Sheet_1.docx

Abstract

Aims: To investigate the association between the degree of ischemia due to coronary microvascular dysfunction (CMD) and the left ventricular (LV) tissue characteristics, systolic performance, and clinical manifestations in hypertrophic cardiomyopathy (HCM). Methods and results: This prospective study enrolled 75 patients with HCM without obstructive epicardial coronary artery disease. Each patient underwent cardiovascular magnetic resonance (CMR) including parametric mapping, perfusion imaging during regadenoson-induced hyperemia, late gadolinium enhancement (LGE) and three-dimensional longitudinal, circumferential, and radial strains analysis. Electrocardiogram, 24 hours Holter recording and cardiopulmonary exercise testing were performed to assess arrhythmias and functional capacity. Mean age was 54.6(14.8) years, 47(63%)males, 51(68%) patients had non obstructive HCM, maximum wall thickness (MWT) was 20.2(4.6)mm, LV ejection fraction 71.6(8.3)%, ischemic burden 22.5(16.9)% of LV. Greater MWT was associated with the severity of ischemia (β-estimate:1.353,95%CI:0.182;2.523,p=0.024). Ischemic burden was strongly associated with higher values of native T1 (β-estimate:9.018, 95%CI:4.721;13.315,p15% (AUC 0.766, sensitivity 0.724, specificity 0.659). Ischemia was also associated with atrial fibrillation/flutter (AF/AFL) (OR-estimate:1.481,95%CI:1.020;2.152,p=0.039), but no association was seen for non-sustained ventricular tachycardia. Ischemia was associated with shorter time to anaerobic threshold (β-estimate:-0.442, 95%CI:-0.860;-0.023,p=0.039). Conclusion: In HCM, ischemia associates with morphological markers of severity of disease, fibrosis, arrhythmia and functional capacity.