Arow Ziad, Nassar Mithal, Monakier Daniel, Assali Abid, Vaknin-Assa Hana, Kornowski Ran, Hamdan Ashraf
Department of Cardiology, Rabin Medical Center - Beilinson Hospital, 49100, Petach Tikva, Israel.
Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Cardiovasc Imaging. 2019 Jul;35(7):1347-1355. doi: 10.1007/s10554-019-01543-7. Epub 2019 Mar 5.
Myocardial crypts can be recognized in patients with hypertrophic cardiomyopathy (HCM) using magnetic resonance imaging, but similar studies using computed tomography (CT) are sparse. The aim of the present study was to evaluate the prevalence and morphology of myocardial crypts in patients with HCM, arterial hypertension, and aortic valve stenosis using contrast-enhanced CT. We also investigated the added value of a finding of myocardial crypts on CT scan to the diagnosis of HCM. The study cohort included 73 patients with HCM, 100 patients with arterial hypertension, 120 patients with aortic valve stenosis, and 100 subjects without cardiovascular disease (normal control group). All underwent evaluation for the presence and dimensions of myocardial crypts using 256-slice CT. Crypts were identified in 18 patients (24.7%) with HCM, 7 patients (7%) with hypertension, 8 patients (6.7%) with aortic valve stenosis, and 4 (4%) normal subjects (P < 0.001). Values of crypt length, width, area, and penetration into myocardium were highest in the HCM group. Crypt area differentiated patients with HCM from patients with arterial hypertension and aortic valve stenosis, and from normal control subjects. Crypt area was an accurate predictor of HCM, with an area under the receiver-operator characteristic curve of 0.88 (95% CI 0.80-0.96). Myocardial crypts identified by CT are more prevalent and larger in area in HCM than in arterial hypertension and aortic valve stenosis. Crypt area could potentially help to improve the diagnosis of HCM by CT beyond the assessment of left ventricular thickness or mass.
使用磁共振成像可在肥厚型心肌病（HCM）患者中识别出心肌隐窝，但使用计算机断层扫描（CT）的类似研究较少。本研究的目的是使用对比增强CT评估HCM、动脉高血压和主动脉瓣狭窄患者中心肌隐窝的患病率和形态。我们还研究了CT扫描发现心肌隐窝对HCM诊断的附加价值。研究队列包括73例HCM患者、100例动脉高血压患者、120例主动脉瓣狭窄患者和100名无心血管疾病的受试者（正常对照组）。所有人均使用256层CT评估心肌隐窝的存在情况和尺寸。在18例（24.7%）HCM患者、7例（7%）高血压患者、8例（6.7%）主动脉瓣狭窄患者和4例（4%）正常受试者中发现了隐窝（P＜0.001）。HCM组的隐窝长度、宽度、面积和心肌穿透深度值最高。隐窝面积可将HCM患者与动脉高血压和主动脉瓣狭窄患者以及正常对照组区分开来。隐窝面积是HCM的准确预测指标，受试者工作特征曲线下面积为0.88（95%CI 0.80 - 0.96）。CT识别出的心肌隐窝在HCM中比在动脉高血压和主动脉瓣狭窄中更普遍且面积更大。除了评估左心室厚度或质量外，隐窝面积可能有助于通过CT改善HCM的诊断。
