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  • Oral presentation
  • Open Access

T1 mapping in discrimination between hypertrophic and hypertensive cardiomyopathy

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Journal of Cardiovascular Magnetic Resonance201416 (Suppl 1) :O61

https://doi.org/10.1186/1532-429X-16-S1-O61

  • Published:

Keywords

  • Late Gadolinium Enhancement
  • Hypertrophic Cardiomyopathy
  • Left Ventricular Wall Thickness
  • Diffuse Myocardial Fibrosis
  • National Health Service Foundation

Background

The differential diagnosis of hypertrophic phenotype remains challenging in clinical practice, in particular between hypertrophy cardiomyopathy (HCM) and increased left ventricular wall thickness (LVWT) due to systemic hypertension. Diffuse myocardial fibrosis is the characteristic feature in HCM, whereas hypertensive response is underpinned by addition of myofibrils in otherwise normal myocardial tissue. Late gadolinium enhancement (LGE) imaging provided important new way of differentiation between these two entities by separating those cases with evidence of regional fibrosis. Whereas approximately 60% of patients with HCM reveal visually discernable LGE, T1 mapping is highly discriminative, irrespective of the presence of LGE.

Methods

Sixty patients with diagnosis of unequivocally hypertrophic cardiomyopathy and fifty patients with hypertensive cardiomyopathy underwent routine cardiac MRI protocol including assessment of function and scar (3-Tesla). T1 values were measured conservatively within septal myocardium in midventricular short-axis slice prior to administration of 0.2 mmol/kg of gadobutrol.

Results

HCM group showed higher LV mass and maximum LVWT than the hypertensive group (HCM vs. hypertensive: LVmass, g/m2: 97 ± 31 vs. 69 ± 22; maximum LVWT 18.4 ± 3 vs. 13.3 ± 1.4, p < 0.0001). There was LGE in 20% of hypertensive (n = 10, 4 of them with an ischaemic pattern) and in 84% of hypertrophic cardiomyopathy (n = 50, 3 of them with an ischaemic pattern) (p < 0.001). Patients with HCM showed significantly higher T1 values compared to hypertensive patients (HCM vs. hypertensive, msec: 1164 ± 45 vs. 1049 ± 31, < 0.0001). Native T1 values were concordant to LVWT and LV mass (r = 0.52 and r = 0.46, p < 0.001, respectively). T1native held superior diagnostic accuracy compared to conventional functional parameters and the presence of LGE to discriminate between hypertrophic or hypertensive cardiomyopathy (Figure 1). T1 native was identified as an independent discriminator between the two conditions.
Figure 1
Figure 1

Diagnostic Performance of T1 Mapping compared with LV mass, maximum LVWT and the presence of LGE in the differentiation between HCM and hypertensive cardiomyopathy.

Conclusions

We demonstrate that native T1 values can reliably discriminate between hypertrophic and hypertensive cardiomyopathy. We propose that native T1 may serve as a novel diagnostic marker to discriminate between the two hypertrophic conditions.

Funding

We would like to acknowledge Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital National Health Service Foundation Trust. Dr. Rocio Hinojar was supported by the Fundacion Alfonso Martin Escudero.

Authors’ Affiliations

(1)
Cardiovascular Imaging Department, King's College London, London, UK, London, UK

Copyright

© Hinojar et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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