Department of Radiology, Heart of England NHS Foundation Trust, Birmingham, West Midlands, UK.
Department of Cardiology, Heart of England NHS Foundation Trust, Birmingham, West Midlands, UK.
Clin Radiol. 2014 Mar;69(3):221-30. doi: 10.1016/j.crad.2013.11.012. Epub 2014 Jan 10.
Hypertrophic cardiomyopathy (HCM) is the most common inheritable cardiovascular disorder. Although many HCM patients remain asymptomatic, sudden death (SD) can occur as the initial manifestation of the disease. It has been hypothesized that myocardial architectural disorganization and scarring represent an unstable electrophysiological substrate that creates susceptibility to malignant ventricular arrhythmias. Cardiovascular magnetic resonance imaging (CMR) is widely used for the diagnosis of HCM, especially in patients with an incomplete or inconclusive echocardiography study. CMR can provide precise non-invasive assessment of biventricular function, wall thickness, and assessment of myocardial fibrosis, using inversion recovery gadolinium-enhanced sequences. CMR is also one of the most promising avenues of research in HCM, and in recent years, has provided many new insights and identified a number of potential adverse prognostic indicators for SD. Future work is still needed to integrate CMR findings into traditional risk assessment algorithms. This paper reviews the evolving role of CMR for risk stratification in HCM including assessment of myocardial hypertrophy, fibrosis and ischaemia.
肥厚型心肌病（HCM）是最常见的遗传性心血管疾病。尽管许多 HCM 患者无症状，但猝死（SD）可作为疾病的初始表现。据推测，心肌结构紊乱和瘢痕形成代表不稳定的电生理基质，易发生恶性室性心律失常。心血管磁共振成像（CMR）广泛用于 HCM 的诊断，特别是在超声心动图检查不完整或不确定的患者中。CMR 可以使用反转恢复钆增强序列提供左右心室功能、壁厚度和心肌纤维化的精确无创评估。CMR 也是 HCM 中最有前途的研究途径之一，近年来为 SD 提供了许多新的见解和确定了一些潜在的不良预后指标。仍需要进一步的工作将 CMR 结果整合到传统的风险评估算法中。本文综述了 CMR 在 HCM 危险分层中的作用的演变，包括心肌肥厚、纤维化和缺血的评估。
