title: High sensitivity of late gadolinium enhancement for predicting microscopic myocardial scarring in biopsied specimens in hypertrophic cardiomyopathy.
abstract: BACKGROUND
  Myocardial scarring can be assessed by cardiac magnetic resonance imaging with late gadolinium enhancement and by endomyocardial biopsy. However, accuracy of late gadolinium enhancement for predicting microscopic myocardial scarring in biopsied specimens remains unknown in hypertrophic cardiomyopathy. We investigated whether late gadolinium enhancement in the whole heart reflects microscopic myocardial scarring in the small biopsied specimens in hypertrophic cardiomyopathy.
  
  
  RESULTS
  Twenty-one consecutive patients with hypertrophic cardiomyopathy who were examined both by cardiac magnetic resonance imaging and by endomyocardial biopsy were retrospectively studied. The right interventricular septum was the target site for endomyocardial biopsy in all patients. Late gadolinium enhancement in the ventricular septum had an excellent sensitivity (100%) with a low specificity (40%) for predicting microscopic myocardial scarring in biopsied specimens. The sensitivity of late gadolinium enhancement in the whole heart remained 100% with a specificity of 27% for predicting microscopic myocardial scarring in biopsied specimens. Quantitative assessments of fibrosis revealed that the extent of late gadolinium enhancement in the whole heart was the only independent variable related to the microscopic collagen fraction in biopsied specimens (β  =  0.59, 95% confident interval: 0.15 - 1.0, p  =  0.012).
  
  
  CONCLUSIONS
  Although there was a compromise in the specificity, the sensitivity of late gadolinium enhancement was excellent for prediction of microscopic myocardial scarring in hypertrophic cardiomyopathy. Moreover, the severity of late gadolinium enhancement was independently associated with the quantitative collagen fraction in biopsied specimens in hypertrophic cardiomyopathy. These findings indicate that late gadolinium enhancement can reflect both the presence and the extent of microscopic myocardial scarring in the small biopsied specimens in hypertrophic cardiomyopathy.
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan; Research and Education Center for Innovative and Preventive Medicine, Kanazawa University, Kanazawa, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Konno
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Fujino
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Nagata
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Hodatsu
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Masuta
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sakata
authors.affiliation: Research and Education Center for Innovative and Preventive Medicine, Kanazawa University, Kanazawa, Japan; Department of Public Health, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Masa-aki
authors.initials: MA
authors.lastname: Kawashiri
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan; Research and Education Center for Innovative and Preventive Medicine, Kanazawa University, Kanazawa, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
mesh_terms: D001706:Biopsy; D002312:Cardiomyopathy, Hypertrophic / Q000473:pathology*; D002921:Cicatrix / Q000175:diagnosis* / Q000378:metabolism; D003094:Collagen / Q000378:metabolism; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D003094:Collagen; D005682:Gadolinium