Myocardial Scar Detected by Contrast-Enhanced Cardiac Magnetic Resonance Imaging is Associated with Ventricular Tachycardia in Hypertrophic Cardiomyopathy Patients

Introduction

Hypertrophic cardiomyopathy (HCM) is associated with myocardial scarring and ventricular tachycardia (VT). Contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) can quantify myocardial scar, and scar imaging has been documented in patients with HCM. We investigated the assessment of myocardial scar in HCM patients using CE-CMR, and its correlation with proven VT.

Methods

Twenty-five patients (mean age 54±8) with HCM who underwent CE-CMR were identified, and clinical data obtained from chart review. Parameters of LV function were calculated from cine imaging, and myocardial scar was assessed using delayed enhancement imaging following gadolinium administration.

Results

Myocardial scar was detected in 16 (64%) patients with a mean mass 9±15g. Scar was patchy, mid-myocardial and located in the basal anteroseptum, and RV insertion sites. Scar was seen in septal, apical and concentric variants of HCM. Scar mass correlated with both LV Mass (r²=0.74) and maximal LV wall thickness (r²=0.42). VT occurred in 32% of patients, and was associated with both increased scar mass and wall thickness compared to non-VT patients (21±22g vs. 4±6g, and 2.4±0.5cm vs. 1.8±0.5cm, p<0.05). LV size and function were similar in patients with and without VT. A scar mass of >7g predicted the presence of VT with a sensitivity of 75% and specificity 82%.

Conclusions

Myocardial scar imaged by CE-CMR is common in patients with HCM, and is predictive of VT. Scar is seen in all HCM variants, and is associated with maximal wall thickness. There may be a role for CE-CMR in improved risk stratification for individual patients with HCM.

Keywords: Cardiac magnetic resonance imaging, Hypertrophic cardiomyopathy, Ventricular tachycardia