Cardiovascular Magnetic Resonance Unit and the NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, UK.
Circ Cardiovasc Imaging. 2014 Mar;7(2):259-64. doi: 10.1161/CIRCIMAGING.113.001241. Epub 2014 Feb 7.
Crypts or clefts in the left ventricular inferobasal myocardium have been detected by cardiovascular magnetic resonance (CMR), but the extent to which they represent prephenotypic markers of hypertrophic cardiomyopathy (HCM) or incidental structural variants remains controversial.
We examined retrospectively the routine vertical long-axis cines in 686 consecutive patients (48±20 years, 55% men) referred for CMR. Crypts were identified in 46 (6.7%), 17 being among patients (8.7% of 196) with otherwise normal CMR findings and without a known family history of HCM. Higher percentages were found in patients with HCM (16%), myocarditis (15%), and hypertension (14%) but without reaching statistical significance (P=0.12). Only 1 (5%) of 20 phenotype-negative HCM family members had a visible crypt. Relative to those without, patients with crypts had lower indexed left ventricular end-systolic volumes (P=0.042) and higher indexed left and right ventricular stroke volumes (P=0.007 and P=0.015) and ejection fractions (P=0.003 and P=0.021). Crypts tended to narrow in systole, varying slightly in size, shape- and number, without obvious group-related features.
Single or paired inferobasal myocardial crypts were an occasional and by no means rare finding among patients referred for CMR without a pretest suspicion of HCM. This, together with similar previous findings in a cohort of healthy volunteers, supports their being regarded, in such individuals, as incidental variants of local myocardial structure, unlikely to require further investigation. However, a larger registry-type study may be justified to investigate the clinical implications of multiple crypts, especially if associated with HCM family history.
心血管磁共振（CMR）已经检测到左心室下基底部的隐窝或裂隙，但它们在多大程度上代表肥厚型心肌病（HCM）的前表型标志物或偶然的结构变异仍存在争议。
我们回顾性地检查了 686 例连续患者（48±20 岁，55%为男性）的常规垂直长轴电影，这些患者因 CMR 而被转诊。在 46 例（6.7%）患者中发现了隐窝，其中 17 例患者（196 例中有 8.7%）CMR 检查结果正常，且无 HCM 的家族史。在 HCM（16%）、心肌炎（15%）和高血压（14%）患者中发现的比例较高，但无统计学意义（P=0.12）。在 20 名表型阴性的 HCM 家族成员中，只有 1 名（5%）可见隐窝。与无隐窝的患者相比，有隐窝的患者左心室收缩末期容积指数较低（P=0.042），左、右心室搏出量指数较高（P=0.007 和 P=0.015），左、右心室射血分数较高（P=0.003 和 P=0.021）。隐窝在收缩期变窄，大小、形状和数量略有变化，没有明显的组间特征。
在无 HCM 术前可疑的 CMR 检查患者中，单发或成对的下基底部心肌隐窝是一种偶尔且绝不是罕见的发现。这与在健康志愿者队列中的类似先前发现一起，支持将其视为局部心肌结构的偶然变异，在这些个体中不太可能需要进一步检查。然而，为了研究多发性隐窝的临床意义，特别是如果与 HCM 家族史相关，可能需要进行更大的注册研究。
