Rickers Carsten, Wilke Norbert M, Jerosch-Herold Michael, Casey Susan A, Panse Prasad, Panse Neeta, Weil Jochen, Zenovich Andrey G, Maron Barry J
Department of Radiology, Fairview-University Medical Center, Minneapolis, MN, USA.
Circulation. 2005 Aug 9;112(6):855-61. doi: 10.1161/CIRCULATIONAHA.104.507723.
Two-dimensional echocardiography is currently the standard test for the clinical diagnosis of hypertrophic cardiomyopathy (HCM). The present study was undertaken to determine whether cardiac MRI (CMR) affords greater accuracy than echocardiography in establishing the diagnosis and assessing the magnitude of left ventricular (LV) hypertrophy in HCM.
Forty-eight patients (age 34+/-16 years) suspected of having HCM (or with a confirmed diagnosis) were imaged by both echocardiography and CMR to assess LV wall thickness in 8 anatomic segments (total n=384 segments) and compared in a blinded fashion. Maximum LV thickness was similar by echocardiography (21.7+/-9.1 mm) and CMR (22.5+/-9.6 mm; P=0.21). However, in 3 (6%) of the 48 patients, echocardiography did not demonstrate LV hypertrophy, and CMR identified otherwise undetected areas of wall thickening in the anterolateral LV free wall (17 to 20 mm), which resulted in a new diagnosis of HCM. In the overall study group, compared with CMR, echocardiography also underestimated the magnitude of hypertrophy in the basal anterolateral free wall (by 20+/-6%; P=0.001), as well as the presence of extreme LV wall thickness (> or =30 mm) in 10% of patients (P<0.05).
CMR is capable of identifying regions of LV hypertrophy not readily recognized by echocardiography and was solely responsible for diagnosis of the HCM phenotype in an important minority of patients. CMR enhances the assessment of LV hypertrophy, particularly in the anterolateral LV free wall, and represents a powerful supplemental imaging test with distinct diagnostic advantages for selected HCM patients.
二维超声心动图是目前肥厚型心肌病（HCM）临床诊断的标准检查方法。本研究旨在确定心脏磁共振成像（CMR）在HCM诊断及评估左心室（LV）肥厚程度方面是否比超声心动图具有更高的准确性。
48例疑似患有HCM（或确诊）的患者（年龄34±16岁）接受了超声心动图和CMR检查，以评估8个解剖节段的LV壁厚度（共384个节段），并采用盲法进行比较。超声心动图测得的最大LV厚度（21.7±9.1mm）与CMR测得的（22.5±9.6mm；P=0.21）相似。然而，在48例患者中有3例（6%），超声心动图未显示LV肥厚，而CMR发现左心室前外侧游离壁存在未被发现的壁增厚区域（17至20mm），从而得出了新的HCM诊断。在整个研究组中，与CMR相比，超声心动图还低估了前外侧基底游离壁的肥厚程度（低20±6%；P=0.001），以及10%患者中LV壁极厚（≥30mm）的情况（P<0.05）。
CMR能够识别超声心动图不易识别的LV肥厚区域，并且在一小部分重要患者中是HCM表型诊断的唯一依据。CMR增强了对LV肥厚的评估，尤其是在左心室前外侧游离壁，对于特定的HCM患者，它是一种具有明显诊断优势的强大补充成像检查。
