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Abnormal T2-STIR magnetic resonance in hypertrophic cardiomyopathy: a marker of advanced disease and electrical myocardial instability.

Todiere G, Pisciella L, Barison A, Del Franco A, Zachara E, Piaggi P, Re F, Pingitore A, Emdin M, Lombardi M, Aquaro GD - PLoS ONE (2014)

Bottom Line: HyT2 was detected in 27 patients (42%), and subjects with HyT2 showed a greater left ventricle (LV) mass index (p<0.001), lower LV ejection fraction (p = 0.05) and greater extent of LGE (p<0.001) compared to those without HyT2.The presence of HyT2 was associated with lower heart rate variability (p = 0.006) and a higher number of arrhythmic risk factors (p<0.001).In HCM patients, HyT2 upon CMR examination is associated with more advanced disease and increased arrhythmic burden.

View Article: PubMed Central - PubMed

Affiliation: Fondazione G. Monasterio Regione Toscana-National Research Council, Pisa, Italy.

ABSTRACT

Background: Myocardial hyperintensity on T2-weighted short-tau inversion recovery (STIR) (HyT2) cardiac magnetic resonance (CMR) images has been demonstrated in patients with hypertrophic cardiomyopathy (HCM) and is considered a sign of acute damage. The aim of the current study was to evaluate the relationship between HyT2 and both a) markers of ventricular electrical instability and b) clinical and CMR parameters.

Methods: Sixty-five patients underwent a thorough clinical examination, consisting of 24-h ECG recording and CMR examination including functional evaluation, T2-STIR images and late gadolinium enhancement (LGE).

Results: HyT2 was detected in 27 patients (42%), and subjects with HyT2 showed a greater left ventricle (LV) mass index (p<0.001), lower LV ejection fraction (p = 0.05) and greater extent of LGE (p<0.001) compared to those without HyT2. Twenty-two subjects (34%) presented non-sustained ventricular tachycardia (NSVT) on the 24-h ECG recording, 21 (95%) of whom exhibited HyT2. Based on the logistic regression analysis, HyT2 (odds ratio [OR]: 165, 95% CI 11-2455, p<0.001) and LGE extent (1.1, 1.0-1.3, p<0.001) served as independent predictors of NSVT, while the presence of LGE was not associated with NSVT occurrence (p = 0.49). The presence of HyT2 was associated with lower heart rate variability (p = 0.006) and a higher number of arrhythmic risk factors (p<0.001).

Conclusions: In HCM patients, HyT2 upon CMR examination is associated with more advanced disease and increased arrhythmic burden.

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Examples of HCM patients.Case 1: a patient with HCM presenting with HyT2 (arrow in T2-STIR image), myocardial fibrosis (arrow LGE image), and pefusion defect (arrow in the frame of the first pass gadolinium) in the same myocardial segments; Case 2: a patient with HCM having myocardial fibrosis (LGE image) without HyT2 (T2-STIR image); Case 3: a patient with HyT2 (arrow in T2-STIR images) and myocardial fibrosis (arrow in LGE images) having a run of NSVT in the ECG stripe (lower panel).
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pone-0111366-g001: Examples of HCM patients.Case 1: a patient with HCM presenting with HyT2 (arrow in T2-STIR image), myocardial fibrosis (arrow LGE image), and pefusion defect (arrow in the frame of the first pass gadolinium) in the same myocardial segments; Case 2: a patient with HCM having myocardial fibrosis (LGE image) without HyT2 (T2-STIR image); Case 3: a patient with HyT2 (arrow in T2-STIR images) and myocardial fibrosis (arrow in LGE images) having a run of NSVT in the ECG stripe (lower panel).

Mentions: On T2-STIR images, HyT2 was detected in 27 patients (42%), with no sex (p = 0.62) or age (p = 0.10) differences (Figure 1). The relationships between HyT2 and the clinical and CMR parameters are summarized in tables 1 and 2. As shown in table 2, subjects with HyT2 had a greater LV mass index, lower LVEF and higher extent of LGE than those without HyT2. In addition, the prevalence of HyT2 was higher in patients with severely increased LV mass index (26% vs. 17%, p = 0.004), and all patients presenting with systolic dysfunction had HyT2. The extent of HyT2 was significantly lower than that of LGE (p<0.001). In 24 of 27 patients (88%), HyT2 was found in a myocardial region with LGE, whereas HyT2 and LGE were detected in different myocardial regions in 3 subjects.


Abnormal T2-STIR magnetic resonance in hypertrophic cardiomyopathy: a marker of advanced disease and electrical myocardial instability.

Todiere G, Pisciella L, Barison A, Del Franco A, Zachara E, Piaggi P, Re F, Pingitore A, Emdin M, Lombardi M, Aquaro GD - PLoS ONE (2014)

Examples of HCM patients.Case 1: a patient with HCM presenting with HyT2 (arrow in T2-STIR image), myocardial fibrosis (arrow LGE image), and pefusion defect (arrow in the frame of the first pass gadolinium) in the same myocardial segments; Case 2: a patient with HCM having myocardial fibrosis (LGE image) without HyT2 (T2-STIR image); Case 3: a patient with HyT2 (arrow in T2-STIR images) and myocardial fibrosis (arrow in LGE images) having a run of NSVT in the ECG stripe (lower panel).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214734&req=5

pone-0111366-g001: Examples of HCM patients.Case 1: a patient with HCM presenting with HyT2 (arrow in T2-STIR image), myocardial fibrosis (arrow LGE image), and pefusion defect (arrow in the frame of the first pass gadolinium) in the same myocardial segments; Case 2: a patient with HCM having myocardial fibrosis (LGE image) without HyT2 (T2-STIR image); Case 3: a patient with HyT2 (arrow in T2-STIR images) and myocardial fibrosis (arrow in LGE images) having a run of NSVT in the ECG stripe (lower panel).
Mentions: On T2-STIR images, HyT2 was detected in 27 patients (42%), with no sex (p = 0.62) or age (p = 0.10) differences (Figure 1). The relationships between HyT2 and the clinical and CMR parameters are summarized in tables 1 and 2. As shown in table 2, subjects with HyT2 had a greater LV mass index, lower LVEF and higher extent of LGE than those without HyT2. In addition, the prevalence of HyT2 was higher in patients with severely increased LV mass index (26% vs. 17%, p = 0.004), and all patients presenting with systolic dysfunction had HyT2. The extent of HyT2 was significantly lower than that of LGE (p<0.001). In 24 of 27 patients (88%), HyT2 was found in a myocardial region with LGE, whereas HyT2 and LGE were detected in different myocardial regions in 3 subjects.

Bottom Line: HyT2 was detected in 27 patients (42%), and subjects with HyT2 showed a greater left ventricle (LV) mass index (p<0.001), lower LV ejection fraction (p = 0.05) and greater extent of LGE (p<0.001) compared to those without HyT2.The presence of HyT2 was associated with lower heart rate variability (p = 0.006) and a higher number of arrhythmic risk factors (p<0.001).In HCM patients, HyT2 upon CMR examination is associated with more advanced disease and increased arrhythmic burden.

View Article: PubMed Central - PubMed

Affiliation: Fondazione G. Monasterio Regione Toscana-National Research Council, Pisa, Italy.

ABSTRACT

Background: Myocardial hyperintensity on T2-weighted short-tau inversion recovery (STIR) (HyT2) cardiac magnetic resonance (CMR) images has been demonstrated in patients with hypertrophic cardiomyopathy (HCM) and is considered a sign of acute damage. The aim of the current study was to evaluate the relationship between HyT2 and both a) markers of ventricular electrical instability and b) clinical and CMR parameters.

Methods: Sixty-five patients underwent a thorough clinical examination, consisting of 24-h ECG recording and CMR examination including functional evaluation, T2-STIR images and late gadolinium enhancement (LGE).

Results: HyT2 was detected in 27 patients (42%), and subjects with HyT2 showed a greater left ventricle (LV) mass index (p<0.001), lower LV ejection fraction (p = 0.05) and greater extent of LGE (p<0.001) compared to those without HyT2. Twenty-two subjects (34%) presented non-sustained ventricular tachycardia (NSVT) on the 24-h ECG recording, 21 (95%) of whom exhibited HyT2. Based on the logistic regression analysis, HyT2 (odds ratio [OR]: 165, 95% CI 11-2455, p<0.001) and LGE extent (1.1, 1.0-1.3, p<0.001) served as independent predictors of NSVT, while the presence of LGE was not associated with NSVT occurrence (p = 0.49). The presence of HyT2 was associated with lower heart rate variability (p = 0.006) and a higher number of arrhythmic risk factors (p<0.001).

Conclusions: In HCM patients, HyT2 upon CMR examination is associated with more advanced disease and increased arrhythmic burden.

Show MeSH
Related in: MedlinePlus