Abstract
Background: Left ventricular hypertrophy (LVH) may be due to different causes, ranging from benign secondary forms to severe cardiomyopathies. Transthoracic Echocardiography (TTE) and ECG are the first-level examinations for LVH diagnosis. Cardiac magnetic resonance (CMR) accurately defines LVH type, extent and severity. Objectives: to evaluate the diagnostic and prognostic role of CMR in patients with TTE and/or ECG evidence of LVH. Methods: We performed CMR in 300 consecutive patients with echocardiographic and/or ECG signs of LVH. Results: Overall, 275 patients had TTE evidence of LVH, with initial suspicion of hypertrophic cardiomyopathy (HCM) in 132 (44%), cardiac amyloidosis in 41 (14%), hypertensive LVH in 48 (16%), aortic stenosis in 4 (1%), and undetermined LVH in 50 (16%). The initial echocardiographic diagnostic suspicion of LVH was confirmed in 172 patients (57.3%) and changed in 128 patients (42.7%, p < 0.0001): the diagnosis of HCM increased from 44% to 71% of patients; hypertensive and undetermined LVH decreased significantly (respectively to 4% and 5%). CMR allowed for a diagnosis in 41 out of 50 (82%) patients with undetermined LVH at TTE. CMR also identified HCM in 17 out of 25 patients with apparently normal echocardiography but with ECG criteria for LVH. Finally, the reclassification of the diagnosis by CMR was associated with a change in survival risk of patients: after CMR reclassification, no events occurred in patients with undetermined or hypertensive LVH. Conclusions: CMR changed echocardiographic suspicion in almost half of patients with LVH. In the subgroup of patients with abnormal ECG, CMR identified LVH (particularly HCM) in 80% of patients. This study highlights the indication of CMR to better characterize the type, extent and severity of LVH detected at echocardiography and suspected with ECG.
Highlights
The presence of left ventricular hypertrophy (LVH) is a recognized independent risk factor for cardiac-related morbidity and mortality [1]
The findings of the present study can be summarized in the following points: 1. In patients with Left ventricular hypertrophy (LVH) at echocardiography or with ECG signs of hypertrophic phenotype, Cardiac magnetic resonance (CMR) changed the initial echocardiographic suspicion in 42.3% cases, in particular changing the diagnosis of hypertensive LVH in 43% cases
We showed that CMR and Transthoracic Echocardiography (TTE) have discrepancies in the diagnostic definition of the type of LVH, depending on several factors that include the identification of LVH of myocardial segments poorly visualized by TTE, the maximal wall thickness, and the availability of a more accurate analysis of myocardial tissue characterization with late gadolinium enhancement (LGE)
Summary
The presence of left ventricular hypertrophy (LVH) is a recognized independent risk factor for cardiac-related morbidity and mortality [1]. Cardiac magnetic resonance (CMR) has higher potential to define wall thickness and the extent of LVH in comparison to TTE due to higher spatial resolution and multiplanar approach that makes it a three-dimensional imaging technique. This is evident in the apical region that is barely valuable with TTE [5,6]. Cardiac magnetic resonance (CMR) accurately defines LVH type, extent and severity. This study highlights the indication of CMR to better characterize the type, extent and severity of LVH detected at echocardiography and suspected with ECG
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