Aquaro Giovanni Donato, Corsi Elisabetta, Todiere Giancarlo, Grigoratos Crysanthos, Barison Andrea, Barra Valerio, Di Bella Gianluca, Emdin Michele, Ricci Fabrizio, Pingitore Alessandro
Fondazione Toscana G. Monasterio, 56124 Pisa, Italy.
Department of Cardiac and Thoracic medicine, Università degli studi di Pisa, 56126 Pisa, Italy.
J Clin Med. 2022 Jan 27;11(3):651. doi: 10.3390/jcm11030651.
Left ventricular hypertrophy (LVH) may be due to different causes, ranging from benign secondary forms to severe cardiomyopathies. Transthoracic Echocardiography (TTE) and ECG are the first-level examinations for LVH diagnosis. Cardiac magnetic resonance (CMR) accurately defines LVH type, extent and severity.
to evaluate the diagnostic and prognostic role of CMR in patients with TTE and/or ECG evidence of LVH.
We performed CMR in 300 consecutive patients with echocardiographic and/or ECG signs of LVH.
Overall, 275 patients had TTE evidence of LVH, with initial suspicion of hypertrophic cardiomyopathy (HCM) in 132 (44%), cardiac amyloidosis in 41 (14%), hypertensive LVH in 48 (16%), aortic stenosis in 4 (1%), and undetermined LVH in 50 (16%). The initial echocardiographic diagnostic suspicion of LVH was confirmed in 172 patients (57.3%) and changed in 128 patients (42.7%, < 0.0001): the diagnosis of HCM increased from 44% to 71% of patients; hypertensive and undetermined LVH decreased significantly (respectively to 4% and 5%). CMR allowed for a diagnosis in 41 out of 50 (82%) patients with undetermined LVH at TTE. CMR also identified HCM in 17 out of 25 patients with apparently normal echocardiography but with ECG criteria for LVH. Finally, the reclassification of the diagnosis by CMR was associated with a change in survival risk of patients: after CMR reclassification, no events occurred in patients with undetermined or hypertensive LVH.
CMR changed echocardiographic suspicion in almost half of patients with LVH. In the subgroup of patients with abnormal ECG, CMR identified LVH (particularly HCM) in 80% of patients. This study highlights the indication of CMR to better characterize the type, extent and severity of LVH detected at echocardiography and suspected with ECG.
左心室肥厚（LVH）可能由多种不同原因引起，从良性继发性形式到严重的心肌病。经胸超声心动图（TTE）和心电图（ECG）是LVH诊断的一级检查方法。心脏磁共振成像（CMR）能准确界定LVH的类型、范围和严重程度。
评估CMR在有TTE和/或ECG提示LVH的患者中的诊断和预后作用。
我们对300例连续的有超声心动图和/或ECG显示LVH迹象的患者进行了CMR检查。
总体而言，275例患者有TTE提示的LVH，最初怀疑为肥厚型心肌病（HCM）的有132例（44%），心脏淀粉样变性的有41例（14%），高血压性LVH的有48例（16%），主动脉瓣狭窄的有4例（1%），不明原因LVH的有50例（16%）。最初超声心动图对LVH的诊断怀疑在172例患者（57.3%）中得到证实，在128例患者（42.7%，P<0.0001）中发生了改变：HCM的诊断从患者的44%增加到71%；高血压性和不明原因的LVH显著减少（分别降至4%和5%）。CMR使TTE检查中50例不明原因LVH患者中的41例（82%）得以确诊。CMR还在25例超声心动图看似正常但有ECG提示LVH标准的患者中发现了17例HCM。最后，CMR对诊断的重新分类与患者生存风险的改变相关：CMR重新分类后，不明原因或高血压性LVH患者未发生事件。
CMR改变了近一半LVH患者的超声心动图怀疑诊断。在ECG异常的患者亚组中，CMR在80%的患者中识别出LVH（尤其是HCM）。本研究强调了CMR在更好地界定超声心动图检测到并经ECG怀疑的LVH的类型、范围和严重程度方面的应用价值。
