Downloaded from http://heart.bmj.com/ on January 5, 2015 - Published by group.bmj.com
PostScript
CORRESPONDENCE
Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratification of hypertrophic cardiomyopathy (HCM): but what about ‘apical’ HCM? To the Editor, We read with great interest the article by Ismail et al1 looking at the role of late gadolinium enhancement cardiac magnetic resonance (CMR) in the risk stratification of patients with hypertrophic cardiomyopathy (HCM). We would like to congratulate the authors for delineating the interesting findings that the amount of myocardial fibrosis was a strong univariable predictor of sudden cardiac death (SCD) albeit that the effect was not maintained after adjusting for LV-EF. Interestingly, in this study of consecutive referrals of patients with suspected/known HCM to a single large tertiary centre, 18% of the patient cohort had apical HCM phenotype. Traditionally, apical HCM has been considered a rarer variant of HCM, with a prevalence of approximately 7% in previous studies, with known more benign prognosis and lower risk of SCD.2 Anecdotally, in our large tertiary CMR unit, we see a similar 18% of apical HCM phenotype in patients with suspected/ known HCM (as in the current study), suggesting the disease variant is perhaps not as rare as initially thought. This could be explained by the higher diagnostic value of CMR vs echo in detecting apical HCM.3
1898
It would be very interesting to clarify to which extent the findings of this study can be fully applicable to patients with apical HCM. It is not uncommon to find a significant amount of late gadolinium myocardial enhancement (replacement fibrosis) in the hypertrophied apical segments. Does this carry the same risk as demonstrated in Ismail et al1 in a cohort with intrinsic more benign prognosis? Would this yet be another reason in favour of considering apical HCM as a separate entity?4 Amardeep Ghosh Dastidar, Jonathan Rodrigues, Chiara Bucciarelli-Ducci NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK Correspondence to Dr Amardeep Ghosh Dastidar, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol BS2 8HW, UK, [email protected] Acknowledgements NIHR Bristol Biomedical Research Unit in Cardiovascular Medicine. The views expressed are those of the authors and not necessarily those of the National Health Service, National Institute for Health Research or Department of Health. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed.
To cite Ghosh Dastidar A, Rodrigues J, BucciarelliDucci C. Heart 2014;100:1898. Published Online First 23 September 2014
▸ http://dx.doi.org/10.1136/heartjnl-2013-305471
Heart December 2014 Vol 100 No 23
Heart 2014;100:1898. doi:10.1136/heartjnl-2014-306762
REFERENCES 1
2
3
4
Ismail TF, Jabbour A, Gulati A, et al. Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratification of hypertrophic cardiomyopathy. Heart 2014;100:1851–8. Eriksson MJ, Sonnenberg B, Woo A, et al. Long-term outcome in patients with apical hypertrophic cardiomyopathy. J Am Coll Cardiol 2002;39: 638–45. Moon JCC, Fisher NG, McKenna WJ, et al. Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography. Heart 2004;90:645–9. Maron BJ, Haas TS, Kitner C, et al. Onset of apical hypertrophic cardiomyopathy in adulthood. Am J Cardiol 2011;108:1783–7.
Downloaded from http://heart.bmj.com/ on January 5, 2015 - Published by group.bmj.com
Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratification of hypertrophic cardiomyopathy (HCM): but what about 'apical' HCM? Amardeep Ghosh Dastidar, Jonathan Rodrigues and Chiara Bucciarelli-Ducci Heart 2014 100: 1898 originally published online September 23, 2014
doi: 10.1136/heartjnl-2014-306762 Updated information and services can be found at: http://heart.bmj.com/content/100/23/1898.2
These include:
References Email alerting service
This article cites 3 articles, 1 of which you can access for free at: http://heart.bmj.com/content/100/23/1898.2#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
PostScript
CORRESPONDENCE
Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratification of hypertrophic cardiomyopathy (HCM): but what about ‘apical’ HCM? To the Editor, We read with great interest the article by Ismail et al1 looking at the role of late gadolinium enhancement cardiac magnetic resonance (CMR) in the risk stratification of patients with hypertrophic cardiomyopathy (HCM). We would like to congratulate the authors for delineating the interesting findings that the amount of myocardial fibrosis was a strong univariable predictor of sudden cardiac death (SCD) albeit that the effect was not maintained after adjusting for LV-EF. Interestingly, in this study of consecutive referrals of patients with suspected/known HCM to a single large tertiary centre, 18% of the patient cohort had apical HCM phenotype. Traditionally, apical HCM has been considered a rarer variant of HCM, with a prevalence of approximately 7% in previous studies, with known more benign prognosis and lower risk of SCD.2 Anecdotally, in our large tertiary CMR unit, we see a similar 18% of apical HCM phenotype in patients with suspected/ known HCM (as in the current study), suggesting the disease variant is perhaps not as rare as initially thought. This could be explained by the higher diagnostic value of CMR vs echo in detecting apical HCM.3
1898
It would be very interesting to clarify to which extent the findings of this study can be fully applicable to patients with apical HCM. It is not uncommon to find a significant amount of late gadolinium myocardial enhancement (replacement fibrosis) in the hypertrophied apical segments. Does this carry the same risk as demonstrated in Ismail et al1 in a cohort with intrinsic more benign prognosis? Would this yet be another reason in favour of considering apical HCM as a separate entity?4 Amardeep Ghosh Dastidar, Jonathan Rodrigues, Chiara Bucciarelli-Ducci NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK Correspondence to Dr Amardeep Ghosh Dastidar, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol BS2 8HW, UK, [email protected] Acknowledgements NIHR Bristol Biomedical Research Unit in Cardiovascular Medicine. The views expressed are those of the authors and not necessarily those of the National Health Service, National Institute for Health Research or Department of Health. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed.
To cite Ghosh Dastidar A, Rodrigues J, BucciarelliDucci C. Heart 2014;100:1898. Published Online First 23 September 2014
▸ http://dx.doi.org/10.1136/heartjnl-2013-305471
Heart December 2014 Vol 100 No 23
Heart 2014;100:1898. doi:10.1136/heartjnl-2014-306762
REFERENCES 1
2
3
4
Ismail TF, Jabbour A, Gulati A, et al. Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratification of hypertrophic cardiomyopathy. Heart 2014;100:1851–8. Eriksson MJ, Sonnenberg B, Woo A, et al. Long-term outcome in patients with apical hypertrophic cardiomyopathy. J Am Coll Cardiol 2002;39: 638–45. Moon JCC, Fisher NG, McKenna WJ, et al. Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography. Heart 2004;90:645–9. Maron BJ, Haas TS, Kitner C, et al. Onset of apical hypertrophic cardiomyopathy in adulthood. Am J Cardiol 2011;108:1783–7.
Downloaded from http://heart.bmj.com/ on January 5, 2015 - Published by group.bmj.com
Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratification of hypertrophic cardiomyopathy (HCM): but what about 'apical' HCM? Amardeep Ghosh Dastidar, Jonathan Rodrigues and Chiara Bucciarelli-Ducci Heart 2014 100: 1898 originally published online September 23, 2014
doi: 10.1136/heartjnl-2014-306762 Updated information and services can be found at: http://heart.bmj.com/content/100/23/1898.2
These include:
References Email alerting service
This article cites 3 articles, 1 of which you can access for free at: http://heart.bmj.com/content/100/23/1898.2#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
