Fibrosis suggested by 3D contrast-enhanced echocardiography in hypertrophic cardiomyopathy

Abstract

MOTS CLES Fibrose ; Cardiomyopathie hypertrophique Direct visualization of myocardial fibrosis in vivo remains a challenge. In hypertrophic cardiomyopathy, myocardial fibrosis is usually imaged by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR), with major prognostic implications. Extensive areas of collagen within the myocardium produce abnormal reflection of ultrasound. The ability of three-dimensional contrast-enhanced echocardiography (3DCE) to detect myocardial scars was recently emphasized in ischaemic cardiomyopathy. In the cases of three patients with hypertrophic cardiomyopathy, harmonic 3DCE was performed with an iE33 (Philips®) equipped with a matrix array transducer (×4 2—4 MHz). After intravenous injection of contrast (SonoVue®, bolus of 0.5 mL), pyramidal full-volume data sets from the apical transducer position were acquired just after irruption and homogenous distribution of contrast in the left ventricle, with a high mechanical index (0.4). Compression was adjusted to soften the healthy myocardium. Gain settings were optimized. Comparison of 3DCE and LGE-CMR images clearly demonstrated agreement. For patient 1, 3DCE revealed a hyperechogen nodule in the mid septum (Fig. 1, panel 1a). Findings with LGE-CMR correlated with 3DCE, with the visualization of a nodular area of hyperenhancement in the mid septum (Fig. 1, panels 1b and 1c). In patient 2, 3DCE showed an area of hyperechogenicity for basal and mid-septal segments (Fig. 1, panel 2a). LGECMR demonstrated a large area of septal hyperenhancement (Fig. 1, panels 2b and 2c), well correlated with the echocardiographic findings. For patient 3, 3DCE did not show any region of hyperechogenicity (Fig. 1, panel 3a). In the same way, LGE-CMR did not reveal