Aortic stiffness is increased in hypertrophic cardiomyopathy with myocardial fibrosis: novel insights in vascular function from magnetic resonance imaging.
OBJECTIVE
The aim of the study was to determine if patients with hypertrophic cardiomyopathy (HCM), both with and without myocardial fibrosis, have altered aortic stiffness as assessed by magnetic resonance imaging (MRI) pulse wave velocity (PWV) measurements.


BACKGROUND
Abnormal aortic stiffness implies an unfavorable prognosis and has been established in a variety of aortic diseases and ischemic cardiomyopathy. However, the relationship between aortic stiffness and HCM has not been studied previously.


METHODS
The study was institutional review board approved and Health Insurance Portability and Accountability Act of 1996 compliant. Velocity-encoded MRI was performed in 100 HCM and 35 normal control subjects. PWV was determined between the mid-ascending and -descending thoracic aorta. Delayed-enhancement MRI was acquired for identification of myocardial fibrosis.


RESULTS
Mean age was 52.4 years in HCM and 45.3 years in control subjects. The prevalence of myocardial fibrosis in HCM was 70%. PWV was significantly higher in HCM patients compared with control subjects (8.72 +/- 5.83 m/s vs. 3.74 +/- 0.86 m/s, p < 0.0001). PWV was higher (i.e., increased aortic stiffness) in HCM patients with myocardial fibrosis than in those without (9.66 +/- 6.43 m/s vs. 6.51 +/- 3.25 m/s, p = 0.005).


CONCLUSIONS
Increased aortic stiffness, as indicated by increased PWV, is evident in HCM patients, and is more pronounced in those with myocardial fibrosis. Further, aortic stiffening may adversely affect left ventricular performance. In addition, increased aortic stiffness correlates with myocardial fibrosis, and may represent another potentially important parameter for risk stratification in HCM, warranting further study.
Boonyasirinant
Thananya
T
Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Rajiah
Prabhakar
P
Setser
Randolph M
RM
Lieber
Michael L
ML
Lever
Harry M
HM
Desai
Milind Y
MY
Flamm
Scott D
SD
D001011:Aorta / Q000473:pathology* / Q000503:physiopathology; D001018:Aortic Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014694:Ventricular Outflow Obstruction / Q000503:physiopathology