title: Left atrial size and left ventricular hypertrophy correlate with myocardial fibrosis in patients with hypertrophic cardiomyopathy.
abstract: BACKGROUND
  In hypertrophic cardiomyopathy (HCM) risk assessment with respect to sudden cardiac death (SCD) is currently based on the presence or absence of different risk markers (RM). Recently, myocardial fibrosis as detected by gadolinium-enhanced magnetic resonance imaging (GE-MRI) has been suggested as additional RM. We evaluated the prevalence of myocardial fibrosis and examined correlations with other risk markers in patients considered to be at increased risk.
  
  
  METHODS
  We included 50 patients with HCM with > 1 (2-4) RM who underwent GE-MRI to check for myocardial fibrosis. Late enhancement was assessed semi-quantitatively using a 17-segment model of the LV (from 0 = absent, 1 = point-shaped, 2 = limited to 1 LV segment, 3 = involving > or = 2 segments). Outflow obstruction was present in 25 patients, the other 25 (1 after septal ablation and after myectomy) were non-obstructive.
  
  
  RESULTS
  Patients (33 men; mean age 44 +/- 13 years; NYHA class: 2.0 +/- 0.9) had a number of RM of 1.7 +/- 0.8. Evidence of myocardial fibrosis > or = 2 was found in 39 patients (mean score: 2.3 +/- 0.9). Correlations were found between left atrial diameter (eta = 0.5), septum thickness (eta = 0.6), and severity of fibrosis. Patients with fibrosis 2 had larger left atria (50 +/- 7 vs 43 +/- 7 mm, P = 0.007) and a thicker septum both on echocardiography (25 +/- 6 vs 17 +/- 5 mm, P < 0.001) and on GE-MRI (28 +/- 5 vs 20 +/- 4 mm, P = 0.01). No correlations were found between fibrosis score and other RM, global LV mass on GE-MRI, or other clinical variables.
  
  
  CONCLUSIONS
  Left ventricular hypertrophy and left atrial size, as two markers for global disease severity, correlate with the severity of fibrosis on GE-MRI.
authors: Department of Cardiology, Heart and Diabetes Centre North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. Cchrprinz@aol.com
authors: Christian
authors: C
authors: Prinz
authors: Detlef
authors: D
authors: Hering
authors: Thomas
authors: T
authors: Bitter
authors: Dieter
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authors: Faber