Bois John P, Geske Jeffrey B, Foley Thomas A, Ommen Steve R, Pellikka Patricia A
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2017 Feb 15;119(4):643-650. doi: 10.1016/j.amjcard.2016.11.010. Epub 2016 Nov 16.
Left ventricular (LV) wall thickness is a prognostic marker in hypertrophic cardiomyopathy (HC). LV wall thickness ≥30 mm (massive hypertrophy) is independently associated with sudden cardiac death. Presence of massive hypertrophy is used to guide decision making for cardiac defibrillator implantation. We sought to determine whether measurements of maximal LV wall thickness differ between cardiac magnetic resonance imaging (MRI) and transthoracic echocardiography (TTE). Consecutive patients were studied who had HC without previous septal ablation or myectomy and underwent both cardiac MRI and TTE at a single tertiary referral center. Reported maximal LV wall thickness was compared between the imaging techniques. Patients with ≥1 technique reporting massive hypertrophy received subset analysis. In total, 618 patients were evaluated from January 1, 2003, to December 21, 2012 (mean [SD] age, 53 [15] years; 381 men [62%]). In 75 patients (12%), reported maximal LV wall thickness was identical between MRI and TTE. Median difference in reported maximal LV wall thickness between the techniques was 3 mm (maximum difference, 17 mm). Of the 63 patients with ≥1 technique measuring maximal LV wall thickness ≥30 mm, 44 patients (70%) had discrepant classification regarding massive hypertrophy. MRI identified 52 patients (83%) with massive hypertrophy; TTE, 30 patients (48%). Although guidelines recommend MRI or TTE imaging to assess cardiac anatomy in HC, this study shows discrepancy between the techniques for maximal reported LV wall thickness assessment. In conclusion, because this measure clinically affects prognosis and therapeutic decision making, efforts to resolve these discrepancies are critical.
左心室（LV）壁厚度是肥厚型心肌病（HC）的一个预后标志物。左心室壁厚度≥30毫米（巨大肥厚）与心源性猝死独立相关。巨大肥厚的存在用于指导心脏除颤器植入的决策。我们试图确定心脏磁共振成像（MRI）和经胸超声心动图（TTE）测量的左心室最大壁厚度是否存在差异。对连续的HC患者进行了研究，这些患者之前未接受过间隔消融或心肌切除术，且在单一的三级转诊中心接受了心脏MRI和TTE检查。比较了两种成像技术报告的左心室最大壁厚度。对至少有一种技术报告为巨大肥厚的患者进行了亚组分析。从2003年1月1日至2012年12月21日，共评估了618例患者（平均[标准差]年龄，53[15]岁；381例男性[62%]）。在75例患者（12%）中，MRI和TTE报告的左心室最大壁厚度相同。两种技术报告的左心室最大壁厚度的中位数差异为3毫米（最大差异为17毫米）。在63例至少有一种技术测量左心室最大壁厚度≥30毫米的患者中，44例患者（70%）在巨大肥厚的分类上存在差异。MRI识别出52例（83%）有巨大肥厚的患者；TTE识别出30例（48%）。尽管指南推荐使用MRI或TTE成像来评估HC中的心脏解剖结构，但本研究显示了两种技术在报告的左心室最大壁厚度评估方面存在差异。总之，由于这一测量在临床上会影响预后和治疗决策，解决这些差异的努力至关重要。
