title: Prevalence of myocardial crypts in a large retrospective cohort study by cardiovascular magnetic resonance.
abstract: BACKGROUND
  Myocardial crypts are discrete clefts or fissures in otherwise compacted myocardium of the left ventricle (LV). Recent reports suggest a higher prevalence of crypts in patients with hypertrophic cardiomyopathy (HCM) and also within small samples of genotype positive but phenotype negative relatives. The presence of a crypt has been suggested to be a predictor of gene carrier status. However, the prevalence and clinical significance of crypts in the general population is unclear. We aimed to determine the prevalence of myocardial crypts in a large cohort of subjects using clinical cardiovascular magnetic resonance (CMR).
  
  
  METHODS
  Consecutive subjects referred for clinical CMR during a 12-month period (n = 1020, age 52.6 ± 17, males: 61%) were included. Crypts were defined as >50% invagination into normal myocardium and their overall prevalence, location and shape was investigated and compared between different patient groups.
  
  
  RESULTS
  The overall prevalence of crypts was 64/1020 (6.3%). In a predefined 'normal' control group the prevalence was lower (11/306, 3.6%, p = 0.031), but were equally prevalent in ischemic heart disease (12/236, 5.1%, p = n/s) and the combined non-ischemic cardiomyopathy (NICM) groups (24/373; 6.4%, p = n/s). Within the NICM group, crypts were significantly more common in HCM (9/76, 11.7%, p = 0.04) and hypertensive CM subjects (3/11, 27%, p = 0.03). In patients referred for CMR for family screening of inherited forms of CM, crypts were significantly more prevalent (10/41, 23%, p < 0.001), including a smaller group with a first degree relative with HCM (3/9, 33%, p = 0.01).
  
  
  CONCLUSIONS
  Myocardial crypts are relatively common in the normal population, and increasingly common in HCM and hypertensive cardiomyopathy. Crypts are also more frequently seen in normal phenotype subjects referred because of a family history of an inherited cardiomyopathy and HCM specifically. It is uncertain what the significance of crypts are in this group, and because of variability in the imaging protocols used and their relative frequency within the normal population, should not be used to clinically stratify these patients. Prospective studies are required to confirm the clinical significance of myocardial crypts, as their significance remains unclear.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Child
authors.forename: Tina
authors.initials: T
authors.lastname: Muhr
authors.forename: Eva
authors.initials: E
authors.lastname: Sammut
authors.forename: Darius
authors.initials: D
authors.lastname: Dabir
authors.forename: Eduardo Arroyo
authors.initials: EA
authors.lastname: Ucar
authors.forename: Tootie
authors.initials: T
authors.lastname: Bueser
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Gill
authors.forename: Gerry
authors.initials: G
authors.lastname: Carr-White
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
authors.forename: Valentina O
authors.initials: VO
authors.lastname: Puntmann
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right