title: Cardiovascular magnetic resonance signs of ischemia in hypertrophic cardiomyopathy.
abstract: BACKGROUND
  Recurrent myocardial ischemia has been recognized as playing an important role in the pathophysiology of hypertrophic cardiomyopathy (HCM) and cardiovascular magnetic resonance (CMR), with or without gadolinium, is a promising method of evaluating fibrosis, edema and hypoperfusion. The aim of this study is to evaluate the interrelationship between late enhancement (LE) and other signs of ischemia, such as edema and perfusion defects, and to relate them to clinical data in order to describe the stage of the disease.
  
  
  METHODS
  Forty-four patients were evaluated by CMR cine images, T2-weighted sequences for edema and LE sequences. First-pass perfusion study was obtained in 37 patients. Acute-subacute ischemic events were clinically defined as the presence of chest pain or new onset of ST-segment depression, end-stage phase by left ventricular ejection fraction <50% and maximal left ventricular wall thickness <25 mm.
  
  
  RESULTS
  Intramural patchy LE was found in 35/44 (80%) patients; extensive LE in 4/44 (9%). Edema was present in 24/44 (54%) patients and perfusion defects in 17/37 (46%). Simultaneous presence of patchy LE, edema and hypoperfusion in corresponding segments, was significantly associated to acute-subacute ischemic-phase parameters (p=0.02; RR 1.99, 95% C.I. 0.77-5.02). Extensive LE and perfusion defects in the absence of edema were significantly related to end-stage HCM (p<0.001; RR 13.7, 95% C.I. 1.83-102.05).
  
  
  CONCLUSIONS
  Using CMR in patients with HCM, we found focal tissue abnormalities consistent with regional ischemia at various stages. CMR provides important, clinically relevant information on the acuity, extent and functional relevance of ischemic injuries in HCM.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. paola.melacini@unipd.it
authors.forename: Paola
authors.initials: P
authors.lastname: Melacini
authors.forename: Francesco
authors.initials: F
authors.lastname: Corbetti
authors.forename: Chiara
authors.initials: C
authors.lastname: Calore
authors.forename: Valentina
authors.initials: V
authors.lastname: Pescatore
authors.forename: Gessica
authors.initials: G
authors.lastname: Smaniotto
authors.forename: Andrea
authors.initials: A
authors.lastname: Pavei
authors.forename: Fabiana
authors.initials: F
authors.lastname: Bobbo
authors.forename: Luisa
authors.initials: L
authors.lastname: Cacciavillani
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology