Differential diagnosis of left ventricular hypertrophy: usefulness of multimodality imaging and tissue characterization with cardiac magnetic resonance.
Differential diagnosis of asymmetrical left ventricular hypertrophy may be challenging, particularly in patients with history of hypertension. A middle-aged man underwent an echocardiographic examination during workup for hypertension, which unexpectedly showed significant asymmetrical septal hypertrophy and raised suspicion for hypertrophic cardiomyopathy. Cardiovascular magnetic resonance confirmed the asymmetrical hypertrophy. No myocardial late gadolinium contrast enhancement was seen. However, precontrast T1 mapping revealed a low native myocardial T1 value. This was highly suggestive of Anderson-Fabry disease, which was subsequently proved with very low alpha galactosidase enzyme levels and mutation analysis. The case illustrates clinical usefulness of multimodality imaging and the novel tissue characterization techniques for assessment of left ventricular hypertrophy.
Cardiovascular MR Unit, Royal Brompton Hospital, London, United Kingdom.|NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
Cemil
C
Izgi
Cardiovascular MR Unit, Royal Brompton Hospital, London, United Kingdom.|NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
Vassilis
V
Vassiliou
Cardiovascular MR Unit, Royal Brompton Hospital, London, United Kingdom.|NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
A John
AJ
Baksi
Cardiovascular MR Unit, Royal Brompton Hospital, London, United Kingdom.|NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
Sanjay K
SK
Prasad
D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009206:Myocardium / Q000473:pathology*
Anderson-Fabry disease; cardiac magnetic resonance imaging; echocardiography; hypertrophic cardiomyopathy; left ventricular hypertrophy