Significance of Late Gadolinium Enhancement at Right Ventricular Attachment to Ventricular Septum in Patients with Hypertrophic Cardiomyopathy

Raymond H. Chan, Barry J. Maron, Iacopo Olivotto, Gabriele E. Assenza, Tammy S. Haas, John R. Lesser, Christiane Gruner, Andrew M. Crean, Harry Rakowski, Ethan Rowin, James Udelson, Massimo Lombardi, Benedetta Tomberli, Paolo Spirito, Francesco Formisano, Martina P. Marra, Elena Biagini, Camillo Autore, Warren J. Manning, Evan AppelbaumWilliam C. Roberts, Cristina Basso, Martin S. Maron

Research output: Contribution to journalArticle

Abstract

Cardiovascular magnetic resonance (CMR) with extensive late gadolinium enhancement (LGE) is a novel marker for increased risk for sudden death (SD) in patients with hypertrophic cardiomyopathy (HC). Small focal areas of LGE confined to the region of right ventricular (RV) insertion to ventricular septum (VS) have emerged as a frequent and highly visible CMR imaging pattern of uncertain significance. The aim of this study was to evaluate the prognostic significance of LGE confined to the RV insertion area in patients with HC. CMR was performed in 1,293 consecutive patients with HC from 7 HC centers, followed for 3.4 ± 1.7 years. Of 1,293 patients (47 ± 14 years), 134 (10%) had LGE present only in the anterior and/or inferior areas of the RV insertion to VS, occupying 3.7 ± 2.9% of left ventricular myocardium. Neither the presence nor extent of LGE in these isolated areas was a predictor of adverse HC-related risk, including SD (adjusted hazard ratio 0.82, 95% confidence interval 0.45 to 1.50, p = 0.53; adjusted hazard ratio 1.16/10% increase in LGE, 95% confidence interval 0.29 to 4.65, p = 0.83, respectively). Histopathology in 20 HC hearts show the insertion areas of RV attachment to be composed of a greatly expanded extracellular space characterized predominantly by interstitial-type fibrosis and interspersed disorganized myocyte patterns and architecture. In conclusion, LGE confined to the insertion areas of RV to VS was associated with low risk of adverse events (including SD). Gadolinium pooling in this region of the left ventricle does not reflect myocyte death and repair with replacement fibrosis or scarring.

Original languageEnglish
Pages (from-to)436-441
Number of pages6
JournalThe American Journal of Cardiology
Volume116
Issue number3
DOIs
Publication statusPublished - Aug 1 2015

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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    Chan, R. H., Maron, B. J., Olivotto, I., Assenza, G. E., Haas, T. S., Lesser, J. R., Gruner, C., Crean, A. M., Rakowski, H., Rowin, E., Udelson, J., Lombardi, M., Tomberli, B., Spirito, P., Formisano, F., Marra, M. P., Biagini, E., Autore, C., Manning, W. J., ... Maron, M. S. (2015). Significance of Late Gadolinium Enhancement at Right Ventricular Attachment to Ventricular Septum in Patients with Hypertrophic Cardiomyopathy. The American Journal of Cardiology, 116(3), 436-441. https://doi.org/10.1016/j.amjcard.2015.04.060