Cardiac Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy: What a Cardiologist Should Know

Abstract

Hypertrophic cardiomyopathy (HCM) affects 1 in 200–500 of the general population, with about 10%–20% identified clinically. The primary goal of imaging for a cardiologist is to provide an accurate diagnosis and add prognostic value. Multiplanar electrocardiogram-gated cardiac magnetic resonance (CMR) imaging can evaluate all phases of the cardiac cycle. CMR excels in the accurate and reproducible evaluation of cardiac morphology, particularly in determining wall thickness and the distribution of hypertrophy. It can also assess the mitral valvular apparatus. Functional evaluation includes assessing contractility, accurate ejection fraction quantification, and visualizing and quantifying dynamic flow, particularly in the subaortic region. CMR strain imaging with feature tracking software evaluates segmental contractility. Late gadolinium enhancement (delayed enhancement), T1, and extracellular volume mapping add to the prognostic ability of CMR magnetic resonance imaging in predicting outcome by evaluating the myocardial fibrosis. CMR also adds value by evaluating the left atrium and right ventricle. A combination of the above helps accurately differentiate between phenotypes of HCM, suggest genetic forms of HCM, and monitor patients after treatment to track disease progression or changes. This review aims to describe the multiparametric strengths of CMR in the diagnosis and prognosis of HCM.

Keywords

• cardiac imaging
• cardiac magnetic resonance imaging
• echocardiography
• hypertrophic cardiomyopathy
• prognosis