title: Progression of myocardial fibrosis assessed with cardiac magnetic resonance in hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  This study sought to assess the rate of progression of fibrosis by 2 consecutive cardiac magnetic resonance (CMR) examinations and its relation with clinical variables.
  
  
  BACKGROUND
  In hypertrophic cardiomyopathy (HCM) myocardial fibrosis, detected by late gadolinium enhancement (LGE), is associated to a progressive ventricular dysfunction and worse prognosis.
  
  
  METHODS
  A total of 55 HCM patients (37 males; mean age 43 ± 18 years) underwent 2 CMR examinations (CMR-1 and CMR-2) separated by an interval of 719 ± 410 days. Extent of LGE was measured, and the rate of progression of LGE (LGE-rate) was calculated as the ratio between the increment of LGE (in grams) and the time (months) between the CMR examinations.
  
  
  RESULTS
  At CMR-1, LGE was detected in 45 subjects, with an extent of 13.3 ± 15.2 g. At CMR-2, 53 (96.4%) patients had LGE, with an extent of 24.6 ± 27.5 g. In 44 patients, LGE extent increased significantly (≥1 g). Patients with apical HCM had higher increments of LGE (p = 0.004) and LGE-rate (p < 0.001) than those with other patterns of hypertrophy. The extent of LGE at CMR-1 and the apical pattern of hypertrophy were independent predictors of the increment of LGE. Patients with worsened New York Heart Association functional class presented higher increase of LGE (p = 0.031) and LGE-rate (p < 0.05) than those with preserved functional status.
  
  
  CONCLUSIONS
  Myocardial fibrosis in HCM is a progressive and fast phenomenon. LGE increment, related to a worse clinical status, is more extensive in apical hypertrophy than in other patterns.
authors.affiliation: Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Todiere
authors.forename: Giovanni Donato
authors.initials: GD
authors.lastname: Aquaro
authors.forename: Paolo
authors.initials: P
authors.lastname: Piaggi
authors.forename: Francesco
authors.initials: F
authors.lastname: Formisano
authors.forename: Andrea
authors.initials: A
authors.lastname: Barison
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Masci
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Strata
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bacigalupo
authors.forename: Mario
authors.initials: M
authors.lastname: Marzilli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pingitore
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D005682:Gadolinium; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D019275:Radiopharmaceuticals; D018401:Sample Size; D013997:Time Factors; D018754:Ventricular Dysfunction / Q000209:etiology / Q000473:pathology
chemical_list: D019275:Radiopharmaceuticals; D005682:Gadolinium