Silvia Ravelli MD, Abstract Co-Author: Nothing to Disclose

Francesco De Cobelli, Abstract Co-Author: Nothing to Disclose

Antonio Esposito MD, Presenter: Nothing to Disclose

Mariangela Cava MD, Abstract Co-Author: Nothing to Disclose

Anna Damascelli MD, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

One of the main issues of hypertrophic cardiomyopathy (HCM) is the increased risk to develop heart failure and life threatening arrhythmias ( 5% annual mortality rate). The aim of our study was to establish relative relevance of morphological, functional and structural information by Cardiac Magnetic Resonance (CMR) related to cardiac clinical events.

50 patients (pts) (age mean 52± standard deviation 16, range 18-85, 40 M, 10 F) affected by HCM underwent CMR between 2004 and 2010. CMR was performed on a 1.5 T magnet (Achieva Philips), with assessment of left ventricular ejection fraction, end-systolic and diastolic volumes, maximum wall thickness (MWT), outflow tract obstruction(OTO), mitral valve incontinence(MVI), end-diastolic wall mass (EDWM),diastolic function (DF) and late-enhancement (LE) after i.v. injection of gadolinium-based contrast medium. Major Adverse Cardiac Events [MACE: sustained ventricular tachycardia, ventricular fibrillation, sudden cardiac death, ICD discharge, atrial fibrillation (AF), unplanned hospital stay, progression to NYHA class III/IV, heart failure (HF) related death] were recorded during the follow up (39±24 months).

We recorded HF related events in 10 pts (2 HF, 8 AF, 6 NYHA progression, 3 Hospital Stay, 2 HF Death). 43/50 pts showed LE (mean LE% amount 10±8) and the mean number of involved segments (LENS) was 4±3. We divided pts into two groups (E=10, no E=40). Comparing the two groups, considering all morphological, functional and structural information assessed by CMR, significant difference were observed in LE% (E= 14±7 vs no E=9±9, p=0,038), LENS (E= 6±3 vs no E= 3±3, p=0,002), MWT (E= 22±4 vs no E= 19±5, p=0,045) and number of patient with DF impairment ( E=9/10 vs no E=14/40, p=0,002). At multivariate analysis (including the parameters which differentiate the two group) age results as the strongest predictor of events, followed by number of LE involved segments; the involvement of any segment results in an increase of HF related events risk (p=0.032, OR=1,6).

Myocardial LE spread , more the LE%, seems to predict evolution towards HF in HCM pts.

Myocardial LE extension should be kept in count in CMR assessment of HCM pts.

Ravelli, S, De Cobelli, F, Esposito, A, Cava, M, Damascelli, A, Del Maschio, A, Myocardial Late-enhancement at Cardiac Magnetic Resonance Affects Evolution towards Heart Failure in Hypertrophic Cardiomyopathy Patients.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034485.html