Clinical Radiology xxx (2014) e163ee164
Contents lists available at ScienceDirect
Clinical Radiology journal homepage: www.clinicalradiologyonline.net
Correspondence
Re: Assessment of coronary microvascular dysfunction in hypertrophic cardiomyopathy: First-pass myocardial perfusion cardiovascular magnetic resonance imaging at 1.5 T
Sir d In a recent issue of Clinical Radiology, Huang et al.1 presented a detailed cardiac magnetic resonance (MR) study of microvascular abnormalities found in 22 hypertrophic cardiomyopathy (HCM) patients, including evaluation of resting first-pass perfusion defects, to illustrate structural disease of the microvasculature. We believe that their work contributes to the greater understanding of HCM and may indeed help physicians to adequately riskstratify and manage their HCM patients in everyday practice. We also believe that the images we present add a new aspect to the issues elaborated by Huang and colleagues and indicate that more research is required in this important area. Non-invasive evaluation of the myocardium in HCM with contrast-enhanced cardiac MR has been the subject of growing literature, recently summarized by Maron.2 In HCM, inherent hypertrophy and myocyte disarray is accompanied by small vessel abnormalities. These include structural remodelling of the microcirculation, reduced arteriolar and capillary density, and interstitial fibrosis,3,4 all of which may contribute to the inability to increase myocardial blood flow in response to augmented oxygen demand. This can result in chronic ischaemia at the microvascular level, myocyte death, and ultimately, replacement fibrosis.5 We found unusually complex microvascular abnormalities in a 60-year-old newly diagnosed HCM patient with no unequivocal indications for an implantable cardioverteredefibrillator (ICD) at presentation [no unexplained syncope, no family history of sudden cardiac death (SCD), septal thickness of
Contents lists available at ScienceDirect
Clinical Radiology journal homepage: www.clinicalradiologyonline.net
Correspondence
Re: Assessment of coronary microvascular dysfunction in hypertrophic cardiomyopathy: First-pass myocardial perfusion cardiovascular magnetic resonance imaging at 1.5 T
Sir d In a recent issue of Clinical Radiology, Huang et al.1 presented a detailed cardiac magnetic resonance (MR) study of microvascular abnormalities found in 22 hypertrophic cardiomyopathy (HCM) patients, including evaluation of resting first-pass perfusion defects, to illustrate structural disease of the microvasculature. We believe that their work contributes to the greater understanding of HCM and may indeed help physicians to adequately riskstratify and manage their HCM patients in everyday practice. We also believe that the images we present add a new aspect to the issues elaborated by Huang and colleagues and indicate that more research is required in this important area. Non-invasive evaluation of the myocardium in HCM with contrast-enhanced cardiac MR has been the subject of growing literature, recently summarized by Maron.2 In HCM, inherent hypertrophy and myocyte disarray is accompanied by small vessel abnormalities. These include structural remodelling of the microcirculation, reduced arteriolar and capillary density, and interstitial fibrosis,3,4 all of which may contribute to the inability to increase myocardial blood flow in response to augmented oxygen demand. This can result in chronic ischaemia at the microvascular level, myocyte death, and ultimately, replacement fibrosis.5 We found unusually complex microvascular abnormalities in a 60-year-old newly diagnosed HCM patient with no unequivocal indications for an implantable cardioverteredefibrillator (ICD) at presentation [no unexplained syncope, no family history of sudden cardiac death (SCD), septal thickness of
