title: Delayed-enhancement MRI of apical hypertrophic cardiomyopathy: assessment of the intramural distribution and comparison with clinical symptoms, ventricular arrhythmias, and cine MRI.
abstract: BACKGROUND
  Hypertrophic cardiomyopathy (HCM) is reported to show patchy midwall myocardial hyperenhancement on delayed-enhancement magnetic resonance imaging (DE-MRI). The intramural distribution of myocardial hyperenhancement and its correlation with clinical symptoms, ventricular arrhythmias, and cardiac function have not been described forsymptomatic apical HCM.
  
  
  OBJECTIVE
  To evaluate the features and significance of myocardial hyperenhancement on DE-MRI insymptomatic apical HCM.
  
  
  METHODS
  Thirteen patients with symptomatic apical HCM and their 65 apical segments were investigated. Myocardial hyperenhancement and regional and global functional parameters were determined with MRI. We investigated the intramural distribution and frequencies of this myocardial hyperenhancement and compared them with the patients' clinical symptoms, the presence of ventricular arrhythmias, and cine MRI.
  
  
  RESULTS
  Eight (61.5%) patients with symptomatic apical HCM displayed apical myocardial hyperenhancement, and 22 (33.8%) of the 65 apical segments examined showed myocardial hyperenhancement. Of the myocardial hyperenhancement observed, 81.8% showed a subendocardial pattern.The hyperenhanced apical myocardium had a lower percentage of systolic myocardial thickening, and was associated with serious symptoms (e.g. syncope) and ventricular arrhythmias.
  
  
  CONCLUSIONS
  Patients with symptomatic apical HCMshowed myocardial hyperenhancement involving the subendocardial layer, which might be related to regional systolic dysfunction, serious clinical symptoms, and ventricular arrhythmias.
authors.affiliation: Department of Radiology, Nippon Medical School, Tokyo, Japan. yas-amano@nifty.com
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Amano
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Fukushima
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Kitamura
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Kumita
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D004562:Electrocardiography; D005260:Female; D005682:Gadolinium; D019786:Gadolinium DTPA; D006571:Heterocyclic Compounds; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D018709:Statistics, Nonparametric; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000473:pathology
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; C064925:gadodiamide; D005682:Gadolinium; D019786:Gadolinium DTPA