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Title: Patterns of Left Ventricular Hypertrophy and Late Gadolinium Enhancement onCardiac Magnetic Resonanace in Patients with Hypertrophic Cardiomyopathy
Authors: Sobia Mehreen, Adeel Ahmed, Abdul Hameed Sidiqqui, Ghulam Rasool Maken, Abdul Rehman Jokhio, Syed Ali Shiram, Javeria Kamran, Nazish Saeed, Waqar, Ismail Ahmed Khan
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2022
Volume: 72
Issue: Supplementary 3
Language: English
DOI: 10.51253/pafmj.v72iSUPPL-3.9546
Keywords: Cardiac magnetic resonance imagingLate gadolinium enhancementHypertrophic cardiomyopathy
Objective: To evaluate the patterns of left ventricular hypertrophy (LVH) and late gadolinium enhancement (LGE) inhypertrophic cardiomyopathy.
Study Design: Analytical cross-Sectional Study.
Place and Duration of Study: Tertiary Cardiac Care Center, Rawalpindi Pakistan from 01 June 2020 to 30 Dec 2021.
Methodology: This study was carried out at a tertiary cardiac care center retrospectively from 1 June 2020 to 31 December 2021. Patients having LV hypertrophy due to aortic stenosis, hypertension, athlete’s heart, and infiltrative disorders were excluded from study. Cases were included using nonprobability consecutive sampling. Sample size estimated by taking 0.2- 0.5 % (1 in 200-500) prevalence of hypertrophic cardiomyopathy using open epi sample size calculator was (n=38) taking 99.99% confidence interval. For the purpose of study all patients with confirmed HCM undergoing CMR during given period were included in study.Approval from the ethical review committee with IERB (IERB letter # 9/2/R&D/2022/179) was sought. CMR was performed using MRI 3 Tesla. Data analysis was done on SPSS version-26. Quantitative variables were expressed as Mean±SD. Qualitative variables were expressed as frequencies and percentages. ANOVA and student t-test (95% CI and 5% margin of error) was applied to compare the study variables. p-vale <0.05 was considered statistically significant.
Results: Majority 77(86.7%) of patients were males. Most common pattern of involvement for LV hypertrophy was asymmetrical septal hypertrophy in 47 (52.8%) followed by apical HCM in 29(32.6%). LVOT obstruction was observed in 30(33.7%) of patients. Mean maximum LV wall thickness was 22mm±5.47.
Conclusion: Our study shows association, between the extent of Late Gadolinium Enhancement and LV wall thickness, myocardial mass index in HCM patients. 
To evaluate the patterns of left ventricular hypertrophy (LVH) and late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy.
Analytical cross-sectional study conducted retrospectively at a tertiary cardiac care center in Rawalpindi, Pakistan, from June 2020 to December 2021. Patients with LV hypertrophy due to aortic stenosis, hypertension, athlete's heart, and infiltrative disorders were excluded. Cardiac Magnetic Resonance (CMR) was performed using a 3 Tesla MRI. Data analysis was conducted using SPSS version-26, with quantitative variables expressed as Mean±SD and qualitative variables as frequencies and percentages. ANOVA and student t-test were applied for comparisons.
graph TD
A["Patient Recruitment"] --> B["Inclusion/Exclusion Criteria"];
B -- Included --> C["Cardiac Magnetic Resonance CMR"];
B -- Excluded --> D["End"];
C --> E["Late Gadolinium Enhancement LGE Imaging"];
E --> F["Data Collection"];
F --> G["Data Analysis SPSS-26"];
G --> H["Statistical Comparisons ANOVA, t-test"];
H --> I["Results Interpretation"];
I --> J["Conclusion"];
Hypertrophic Cardiomyopathy (HCM) is a common genetic cardiac disease. The study found asymmetrical septal hypertrophy to be the most common phenotype, followed by apical HCM. The sigmoid septal morphology was associated with systolic anterior motion (SAM) and LVOT obstruction, while reverse septal curve morphology was linked to younger age, increased LV mass index, and myocardial crypts. LGE was prevalent and predominantly involved the antero-septal wall. The study also noted associations between LGE, LV wall thickness, myocardial mass index, and LVOT obstruction.
The majority of patients (86.7%) were males. The most common pattern of LV hypertrophy was asymmetrical septal hypertrophy (52.8%), followed by apical HCM (32.6%). Left ventricular outflow tract (LVOT) obstruction was observed in 33.7% of patients. Late gadolinium enhancement (LGE) was observed in 85.4% of patients, with diffuse patchy involvement being the most common pattern (71.9%), predominantly in the antero-septal wall (75.3%). The extent of LGE was associated with LV wall thickness, myocardial mass index, cavity obstruction, and increased left atrial volume index (LAVI).
The most common pattern of LVH in this study was asymmetrical septal hypertrophy, followed by apical HCM. Different phenotypes showed significant variations in characteristics. SAM and LVOT obstruction were more frequent in sigmoid morphology compared to reverse septal curve morphology. LGE was observed in most cases, with diffuse patchy involvement of the basal antero-septal wall being common. The presence and extent of LGE were associated with increased LV wall thickness, myocardial mass index, LVOT obstruction, and increased LAVI.
1. Sample Size: The study included 89 patients, which was larger than the initially calculated sample size of 38 based on prevalence estimates.
2. Gender Distribution: 77 (86.7%) of the patients were males.
3. Most Common LVH Pattern: Asymmetrical septal hypertrophy was the most common pattern, observed in 47 (52.8%) of patients.
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