Prevalence and clinical significance of cardiovascular magnetic resonance adenosine stress-induced myocardial perfusion defect in hypertrophic cardiomyopathy

• Published in: Journal of cardiovascular magnetic resonance 2020-05, Vol.22 (1), p.30-30, Article 30
• Main Authors: Kim, Eun Kyoung, Lee, Sang-Chol, Chang, Sung-A, Jang, Shin-Yi, Kim, Sung Mok, Park, Sung-Ji, Choi, Jin-Oh, Park, Seung Woo, Jeon, Eun-Seok, Choe, Yeon Hyeon
• Format: Article
• Language: English
• Subjects: Abnormalities; Adenosine; Adenosine - administration & dosage; Aneurysm; Aneurysms; Angina pectoris; Blood pressure; Cardiomyopathy; Cardiomyopathy, hypertrophic; Cardiomyopathy, Hypertrophic - diagnostic imaging; Cardiomyopathy, Hypertrophic - epidemiology; Cardiomyopathy, Hypertrophic - physiopathology; Cardiovascular disease; Chest pain; Clinical significance; Comparative analysis; Coronary artery; Coronary Circulation; Coronary vessels; Defects; Dyspnea; Echocardiography; Ejection fraction; Electrocardiography; Exercise equipment; Exercise tests; Female; Fitness equipment; Gadobutrol; Gadolinium; Gender; Heart; Heart failure; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine; Male; Medical imaging; Microcirculation; Microvasculature; Middle Aged; Multivariate analysis; Myocardial diseases; Myocardial ischemia; Myocardial perfusion imaging; Myocardial Perfusion Imaging - methods; Perfusion; Predictive Value of Tests; Prevalence; Prospective Studies; Resonance; Respiration; Risk Factors; Seoul - epidemiology; Software; Stress; Studies; Systemic diseases; Tachycardia; Treadmills; Vasodilator Agents - administration & dosage; Ventricle; Ventricular Function, Left; Ventricular Remodeling
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1186/s12968-020-00623-1

Hypertrophic cardiomyopathy (HCM) is thought to be associated with microvascular dysfunction. Adenosine stress-perfusion cardiovascular magnetic resonance imaging (CMR) is a sensitive method for assessing microvascular perfusion abnormalities. We evaluated the prevalence and clinical characteristics of HCM patients with adenosine-induced perfusion defects on CMR. Among 189 consecutive patients with HCM who underwent adenosine-stress perfusion CMR, 115 patients who had clinical, echocardiography, 24-h Holter monitoring and treadmill exercise test data were analyzed. We calculated myocardial perfusion ratio index from the intensity-over-time curve to quantify perfusion defects. The presence and extent of the stress-induced perfusion defect were compared with clinical characteristics, presence and extent of late gadolinium enhancement (LGE), left ventricular (LV) mass index and volume, presence of non-sustained ventricular tachycardia (NSVT) and results of treadmill exercise test. The mean age of enrolled patients was 51.8 ± 11.3 years. Most patients were asymptomatic except 25 subjects presented with New York Heart Association Class II dyspnea and 16 patients with atypical non-exertional chest discomfort. LGE was present in 103 (89.6%) subjects. Adenosine stress-induced perfusion defects were present in 48 (42%) subjects. None of the perfusion defects corresponded with a single or multiple coronary artery territories, showing a multiple patchy pattern in 24 (50.0%), a concentric subendocardial pattern in 20 subjects (41.7%), and as a single blot-like defect in the remaining 4 (8.3%). A perfusion defect was associated with NSVT, LV apical aneurysm, higher LV mass index, and higher LGE volume on univariate analysis. Multivariate analysis revealed female gender (P = 0.008), presence of apical aneurysm and NSVT (P = 0.036 and 0.047, respectively), and LV mass index (P = 0.022) to be independently associated with adenosine stress-induced perfusion defects. In patients with HCM, adenosine-stress perfusion defects on CMR are present in more than 40% of subjects. This perfusion defect is associated with NSVT, higher LV mass index, and apical aneurysms. The prognostic value of this finding needs further elucidation.