Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.
Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.
J Am Soc Echocardiogr. 2021 Dec;34(12):1262-1272. doi: 10.1016/j.echo.2021.07.015. Epub 2021 Aug 8.
Left ventricular (LV) apical aneurysm is a unique morphological entity and novel adverse risk marker existing within the broad phenotypic spectrum of hypertrophic cardiomyopathy (HCM). Its true prevalence in the HCM population is likely underestimated because of inherent limitations of conventional noncontrast echocardiography. The authors hypothesized that contrast echocardiography is a reliable imaging technique compared with cardiovascular magnetic resonance (CMR) for the detection of apical aneurysms. The aim of this study was to assess the effectiveness of contrast echocardiography in the detection of LV apical aneurysms in patients with HCM in comparison with the gold standard, CMR.
One hundred twelve patients with HCM identified from an institutional clinical database, who underwent echocardiographic and CMR examinations within 12 months and had LV apical aneurysms identified on either or both imaging modalities, were retrospectively analyzed. Discordant cases were reviewed by an expert panel, and a consensus was reached regarding the presence or absence of an apical aneurysm. The reason for any discrepancy was recorded.
The mean age of the patients was 59 ± 13 years, and 73% were men. Sixty-four (57%) underwent contrast echocardiography. The median interval between echocardiography and CMR was 118 days (interquartile range, 61-237 days). Thirty-nine patients (35%) had discordance between echocardiographic and CMR findings, of whom 20 had aneurysms reported on echocardiography but not CMR and 19 vice versa. Upon reanalysis by the expert panel, aneurysms were initially missed on CMR in 16 patients (80%), largely because of interpretation error secondary to small aneurysms, with a mean aneurysm size of 0.82 ± 0.38 cm in these cases. Before secondary review by the expert panel, contrast echocardiography had sensitivity of 97% compared with 85% for CMR (P = .0198) and 64% for noncontrast echocardiography (P = .0001). After secondary review, contrast echocardiography had sensitivity of 98% compared with 67% for noncontrast echocardiography (P = .0001) and 97% for CMR (P = 1.00).
Contrast echocardiography has high sensitivity for detecting LV apical aneurysms and should be used routinely in the evaluation and risk stratification of patients with HCM.
左心室（LV）心尖部瘤是肥厚型心肌病（HCM）广泛表型谱内存在的一种独特形态实体和新型不良风险标志物。由于传统非对比超声心动图固有的局限性，其在 HCM 人群中的真实患病率可能被低估。作者假设与心血管磁共振（CMR）相比，对比超声心动图是一种可靠的成像技术，可用于检测心尖部瘤。本研究旨在评估对比超声心动图在检测 HCM 患者 LV 心尖部瘤中的有效性，并与金标准 CMR 进行比较。
从机构临床数据库中回顾性分析了 112 例 HCM 患者，这些患者在 12 个月内接受了超声心动图和 CMR 检查，并且在任意一种或两种影像学检查中均发现了 LV 心尖部瘤。对有差异的病例由专家小组进行复查，并就心尖部瘤的存在与否达成共识。记录出现差异的原因。
患者的平均年龄为 59±13 岁，73%为男性。64 例（57%）进行了对比超声心动图检查。超声心动图和 CMR 之间的中位间隔时间为 118 天（四分位间距，61-237 天）。39 例（35%）的超声心动图和 CMR 检查结果存在差异，其中 20 例在超声心动图上报告有心尖部瘤，但 CMR 上未报告，19 例反之亦然。在专家小组重新分析后，在 16 例患者（80%）中，CMR 最初漏诊了心尖部瘤，主要是由于小的心尖部瘤导致的解释错误，这些患者的心尖部瘤平均大小为 0.82±0.38cm。在由专家小组进行二次复查之前，对比超声心动图的敏感性为 97%，而 CMR 的敏感性为 85%（P=0.0198），非对比超声心动图的敏感性为 64%（P=0.0001）。在二次复查后，对比超声心动图的敏感性为 98%，而非对比超声心动图为 67%（P=0.0001），CMR 为 97%（P=1.00）。
对比超声心动图对检测 LV 心尖部瘤具有高敏感性，应在 HCM 患者的评估和危险分层中常规使用。
