Association of myocardial fibrosis, electrocardiography and ventricular tachyarrhythmia in hypertrophic cardiomyopathy: a delayed contrast enhanced MRI study

  • Deborah H. Kwon
  • Randolph M. Setser
  • Zoran B. Popović
  • Maran Thamilarasan
  • Srikanth Sola
  • Paul Schoenhagen
  • Mario J. Garcia
  • Scott D. Flamm
  • Harry M. Lever
  • Milind Y. Desai
Original Paper


Background Patients with hypertrophic cardiomyopathy (HCM) are predisposed to ventricular tachyarrhythmia (VT); likely due to myocardial fibrosis or disarray. Delayed hyperenhancement magnetic resonance imaging (DHE-MRI) accurately detects myocardial fibrosis (scar). We sought to determine the association between septal thickness, myocardial scar and VT. Methods Sixty-eight patients (mean age 44 years, 69% males) with documented HCM underwent cine MRI (Siemens Sonata or Avanto 1.5 T scanner, Erlangen, Germany) in short axis, 2, 3 and 4-chamber views and maximal interventricular septal thickness was recorded at end-diastole. Corresponding DHE-MR images (8–10 mm thick) were obtained, ∼20 min after injection of 0.2 mmol/kg of Gadolinium. Scar was determined semi-automatically (as % of total myocardium) using VPT software (Siemens) and defined as intensity >2 SD above viable myocardium in a 12 segment short-axis model at apex, mid LV and base. Presence of VT (documented on ambulatory ECG monitoring) and history of sudden death were recorded. Results One patient had a history of sudden death and 9 (13%) had VT on ambulatory ECG monitoring. On DHE-MRI, 39 (57%) patients had myocardial scar. Patients with VT had significantly higher scar %, compared to those without: 14% [6, 19] vs. 6% [0, 10], P = 0.01. On logistic regression, only the size of the scar was a significant predictor of VT (P = 0.03). Conclusions HCM subjects with VT have a higher % of myocardial scarring noted on DHE-MRI, independent of septal thickness or beta-blocker use.


Hypertrophic cardiomyopathy Electrocardiography Magnetic resonance imaging Delayed hyperenhancement Ventricular tachyarrhythmia 



The authors would like to thank Ms. Joan Weaver RT (MRI) and Ms. Angel Lawrence RT (MRI) for their help in acquisition of MRI images. Disclosure: The institution receives modest research support from Siemens Medical Solutions, Germany.


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Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Deborah H. Kwon
    • 1
  • Randolph M. Setser
    • 2
  • Zoran B. Popović
    • 1
  • Maran Thamilarasan
    • 1
  • Srikanth Sola
    • 1
    • 2
  • Paul Schoenhagen
    • 1
    • 2
  • Mario J. Garcia
    • 1
  • Scott D. Flamm
    • 1
    • 2
  • Harry M. Lever
    • 1
  • Milind Y. Desai
    • 1
    • 2
  1. 1.Department of Cardiovascular Medicine, Desk F 15Cleveland ClinicClevelandUSA
  2. 2.Department of RadiologyCleveland ClinicClevelandUSA

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