MRI late gadolinium enhancement of left ventricular apical aneurysms in hypertrophic cardiomyopathy / 中华放射学杂志

ABSTRACT

Objectives To discuss the characteristics of late gadolinium enhancement (LGE) magnetic resonance (MR) imaging in patients with hypertrophic cardiomyopathy (HCM) and left ventricular apical aneurysm (LVAA) and its related prognostic value. Methods Thirty HCM patients with LVAA were collected from August 2004 to August 2013. All cases with coronary artery diseases were ruled out, and all patients underwent LGE derived by cardiac MR (CMR). Five cases of LVAA were pathological confirmed. Atrial and ventricular diameters, apical aneurysm diameters and left ventricular ejection fraction were measured, and apical aneurysm LGE was evaluated. All patients were then followed up. Comparisons in continuous parameters between patients with or without LGE were performed by independent t test. A Cox proportional hazard model was used to estimate the hazard rate for adverse cardiovascular events. Results LGE was identified in 21 LVAAs and non-LGE in 9 LVAAs. Between two groups, there was no significant difference in the size of LVAA [(16.4 ± 11.5) mm vs. (20.3 ± 9.8) mm, P=0.63]. In particular, the complete transition from non-LGE to LGE LVAA was recorded during follow-up in one patient. Pathological findings confirmed that LGE indicated fibrous tissue in LVAA, and LVAA without LGE indicated viable myocardium. The follow-up suggested that the patterns and the size of LVAA were associated with the adverse events in these patients (LGE of LVAA, HR=7.94, P=0.064; the size of LVAA, HR=1.08, P=0.009). Conclusions LGE-MR had important clinical significance in HCM patients with LVAA. LGE in LVAA corresponded with the fibrous tissue and was associated with the prognosis.