Role of cardiac magnetic resonance imaging in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy

Yıl 2022, Cilt: 47 Sayı: 2, 811 - 819, 30.06.2022

Arda Güler , Ahmet Anıl Şahin , Sinem Aydin , Servet Umut Uçar , Begüm Uygur , Ömer Çelik , Mehmet Erturk

https://doi.org/10.17826/cumj.1086581

Öz

Purpose: The present study sought to investigate the association between Cardiac magnetic resonance (CMR) imaging parameters including late gadolinium enhancement (LGE), total left ventricular mass (TLVM), mitral regurgitation, and left atrial (LA) volume, with atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM). patients.
Materials and Methods: Consecutive 122 patients with the diagnosis of HCM and together with having 48-hour Holter monitoring were included in the present work. Two experienced observers evaluated all CMR images. The correlation between AF and CMR parameters including TLVM, LA volume, the presence and extent of LGE, mitral regurgitation, and the maximum left ventricular thickness were evaluated.
Results: Between the LA volume and AF, a significant correlation was observed. Additionally, TLVM was also associated with AF. The logistic multivariate analysis assessing TLVM, LA volume, and the extent of LGE revealed that only the left atrial volume was the independent predictor. Significant correlations were observed between the existence and extent of LGE, TLVM, mitral regurgitation and LA volume.
Conclusion: The presence of LGE was positively correlated with LA volume. LA volume appears to be the most important independent predictor of AF in HCM patients.

Anahtar Kelimeler

Hypertrophic cardiomyopathy, Atrial Fibrillation, CMR, late gadolinium enhancement, Atrial volume

Hipertrofik kardiyomiyopati hastalarında atriyal fibrilasyon gelişimini öngörmede kardiyak manyetik rezonans görüntülemenin rolü

Öz

Amaç:, Bu çalışmada Hipertrofik kardiyomiyopati (HKMP) hastalarında geç kontrast tututulmu (GKT), toplam sol ventrikül kütlesi (TSVK), mitral yetersizlik ve sol atriyum (SA) hacmi dahil olmak üzere Kardiyak manyetik rezonans (KMR) görüntüleme parametreleri ile atriyal fibrilasyon (AF) arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: Bu çalışmaya HKMP tanısı alan, KMR çekimi yapılmış ve 48 saatlik Holter monitorizasyonu olan ardışık 122 hasta dahil edilmiştir. KMR tecrübesine sahip Radyoloji ve Kardiyoloji uzman hekimleri tarafından KMR görüntüleri değerlendirilmiştir. TSVK, SA hacmi, GKT varlığı ve yaygınlığı, mitral yetersizliği ve maksimum sol ventrikül kalınlığını içeren KMR parametreleri ile AF arasındaki korelasyon değerlendirilmiştir.
Bulgular: SA hacmi ve AF arasında anlamlı bir korelasyon gözlendi. Ek olarak TSVK, AF ile ilişkili bulundu. TSVK, SA hacmi ve GKT'nin kapsamını değerlendiren lojistik çok değişkenli analiz, yalnızca sol atriyal hacmin bağımsız öngörücü olduğunu ortaya koydu. GKT, TSVK, mitral yetersizlik ve SA hacminin varlığı ve yaygınlığı arasında anlamlı korelasyonlar gözlendi.
Sonuç: GKT'nin varlığı, SA hacmi ile pozitif korelasyon gösterdi. SA hacmi, HKMP hastalarında AF'nin en önemli bağımsız belirleyicisi gibi görünmektedir.

Anahtar Kelimeler

Hipertrofik Kardiyomiyopati, Atriyal Fibrilasyon, Kardiyak MR, Sol Atriyum Hacmi, geç kontrast tutulumu

Kaynakça

• 1. Kovacic JC, Muller D. Hypertrophic cardiomyopathy: State-of-the-art review, with focus on the management of outflow obstruction. Intern Med J. 2003;33:521–529.
• 2. Elliott P, McKenna WJ. Hypertrophic cardiomyopathy. Lancet. 2004;363:1881–1891.
• 3. Hughes SE. The pathology of hypertrophic cardiomyopathy. Histopathology. 2004;44:412–427.
• 4.Wigle ED. Cardiomyopathy: the diagnosis of hypertrophic cardiomyopathy. 2001;86:709–714.
• 5. Shirani J, Pick R, Roberts WC, Maron BJ. Morphology and significance of the left ventricular collagen network in young patients with hypertrophic cardiomyopathy and sudden cardiac death. J Am Coll Cardiol. 2000;35:36–44.
• 6. Anderson KR, Sutton MG, Lie JT. Histopathological types of cardiac fibrosis in myocardial disease. J Pathol. 1979;128:79–85.
• 7. Moon JC, Reed E, Sheppard MN, Elkington AG, Ho SY, Burke M, et al. The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2004;43:2260–2264.
• 8. Nagueh SF, Bierig SM, Budoff MJ, Desai M, Dilsizian V, Eidem B et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy: Endorsed by the American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2011;24:473-98.
• 9. Maron MS, Lesser JR, Maron BJ. Management implications of massive left ventricular hypertrophy in hypertrophic cardiomyopathy significantly underestimated by echocardiography but identified by cardiovascular magnetic resonance. Am J. 2010;105:1842-1843.
• 10. Moon JC, McKenna WJ. The emerging role of cardiovascular magnetic resonance in refining the diagnosis of hypertrophic cardiomyopathy. Nat Clin Pract Cardiovasc Med. 2009;6:166-7.
• 11. Teraoka K, Hirano M, Ookubo H, Sasaki H, Katsuyama H, Amino M et al. Delayed contrast enhancement of MRI in hypertrophic cardiomyopathy. Magn Reson Imaging. 2004;22:155–161.
• 12. Papavassiliu T, Schnabel P, Schröder M, Borggrefe M. CMR scarring in a patient with hypertrophic cardiomyopathy correlates well with histological findings of fibrosis. Eur Heart J. 2005;26:2395.
• 13. Adabag AS, Maron BJ, Appelbaum E, Harrigan CJ, Buros JL, Gibson CM et al. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol. 2008;51:1369-74.
• 14. Fluechter S, Kuschyk J, Wolpert C, Doesch C, Veltmann C, Haghi D et al. Extent of late gadolinium enhancement detected by cardiovascular magnetic resonance correlates with the inducibility of ventricular tachyarrhythmia in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson. 2010;12:30.
• 15. Kwon DH, Setser RM, Popovic ZB, Thamilarasan M, Sola S, Schoenhagen P et al. Association of myocardial fibrosis, electrocardiography and ventricular tachyarrhythmia in hypertrophic cardiomyopathy: a delayed contrast enhanced MRI study. Int J Cardiovasc Imaging. 2008;24:617-25.
• 16. Tuluce K, Tuluce SY. Predictors of Atrial Fibrillation Risk in Hypertrophic Cardiomyopathy. J Atr Fibrillation. 2015;7:1200.
• 17. Maron BJ, Maron MS, Semsarian C. Genetics of hypertrophic cardiomyopathy after 20 years: clinical perspectives. J Am Coll Cardiol. 2012;60:705–15.
• 18. Di Donna P, Olivotto I, Delcre SD, Caponi D, Scaglione M, Naultet I et al. Efficacy of catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: impact of age, atrial remodelling, and disease progression. Europace. 2010;12: 347–55.
• 19. Providencia R, Elliott P, Patel K, McCready J, Babu G, Srinivasan N et al. Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis. Heart. 2016;102:1533–43.
• 20. Vaidya K, Semsarian C, Chan KH. Atrial fibrillation in hypertrophic cardiomyopathy. Heart Lung Cir. 2017;26:975-982.
• 21. Siontis KC, Geske JB, Ong K, Nishimura RA, Ommen SR, Gersh BJ. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population. J Am Heart Assoc. 2014;3:001-002.
• 22. Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE et al. ACC/ESC clinical expert consensus document on hypertrophic cardiomyopathy: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines (Committee to Develop an Expert Consensus Document on Hypertrophic Cardiomyopathy). J Am Coll Cardiol. 2003;42:410-418.
• 23. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105:539Y542.
• 24. Pujadas S, Vidal-Perez R, Hidalgo A, Leta R, Carreras F, Barros A et al. Correlation between myocardial fibrosis and the occurrence of atrial fibrillation in hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study. Eur J Radiol. 2010;75:88-91.
• 25. Papavassiliu T. Germans T, Flüchter S, Doesch C, Suriyakamar A, Haghi D et al. CMR findings in patients with hypertrophic cardiomyopathy and atrial fibrillation. J Cardiovasc Magn Reson. 2009;11:34.
• 26. Maron NJ, Haas TS, Maron MS, Lesser JR, Browning JA, Chan RH et al. Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance. Am J Cardiol. 2014;113:1394-1400.
• 27. Tani T, Tanabe K, Ono M, Yamaguchi K, Okada M, Sumida T et al. Left atrial volume and the risk of paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr. 2004;17:644–648.
• 28. Ozdemir O, Soylu M, Demir AD, Topaloglu S, Alyan O, Turhan H et al. P-wave durations as a predictor for atrial fibrillation development in patients with hypertrophic cardiomyopathy. Int J Cardiol. 2004;94:163–166.
• 29. Guttmann OP, Rahman MS, O’Mahony C, Anastasakis A, Elliott PM. Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review. Heart. 2014;100:465–472.
• 30. Kramer CM, DiMarco JP, Kolm P, Ho CY, Desai MY, Kwong RY et al. Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR. JACC Clin Electrophysiol. 2021;7:1376-1386.
• 31. Amano Y, Takayama M, Takahama K, Kumazaki T. Delayed hyperenhancement of myocardium in hypertrophic cardiomyopathy with asymmetrical septal hypertrophy: Comparison with global and regional cardiac MR imaging appearances, J Magn Reson Imaging. 2004;20:595-600.
• 32. Briasoulis A, Mallikethi-Reddy S, Palla M, Alesh I, Afonso L. Myocardial fibrosis on cardiac magnetic resonance and cardiac outcomes in hypertrophic cardiomyopathy: a meta-analysis. Heart. 2015;101:1406-1411.
• 33. Nair AG, Fischer AG. Atrial fibrillation in hypertrophic cardiomyopathy: mechanisms, embolic risk and prognosis, Anadolu Kardiyol Derg. 2006;6:40–3.
• 34. Maron MS, Appelbaum E, Harrigan CJ. Clinical profile and significance of delayed enhancement in hypertrophic cardiomyopathy. Circ Heart Fail. 2008;1:184-91.