Abstract
This is the case of a 32-years-old male who presented with giddiness, sweating, palpitations, and breathlessness since 6 months. He was nondiabetic and nonhypertensive and had no family history of sudden cardiac deaths in the family. Electrocardiogram showed no significant abnormality. 2D echocardiography revealed features suggestive of hypertrophic cardiomyopathy. Holter monitoring revealed no evidence of ventricular tachycardia. Cardiac MR was advised for assessment of myocardial scarring.
The findings in the cardiac magnetic resonance imaging (MRI) included thickening of interventricular septum measuring 2.5 cm in end diastole (image A, B). Narrowing of the left ventricular outflow tract (image D) and systolic anterior motion of mitral valve (image C). On postcontrast delayed sequences, there were areas of mid myocardial late gadolinium enhancement (myocardial scarring) in the anteroseptal segments at apical and mid cavity level corresponding to right ventricular insertion site of septum (long arrow in image E). There were also patchy areas of mid myocardial enhancement along the septum (short arrow in image E).
Quantification and characterization of late gadolinium enhancement (myocardial scarring) is a measure of disease severity, risk stratification, and prognostication. The presence of late gadolinium enhancement in cardiac MR imaging has proven to be a good predictor of adverse outcomes and aids in selection of candidates for intracardiac defibrillator (ICD) placement.
Cardiac MRI findings in a 32-years-old male who presented with syncope. (A, B) Precontrast 4 chamber and short axis 2 chamber view depicts thickening of interventricular septum and walls of left ventricle (arrows in A and B). There is systolic anterior motion of mitral valve during systole (arrow in C) and narrowing of left ventricular outflow tract (LVOT) leading to turbulence indicated by dephasing signals (arrow in D). (E) Postcontrast short-axis image depicts late gadolinium enhancement (myocardial scarring) (long arrow in E) in the anteroseptal segments corresponding to right ventricle (RV) attachment of septum classical of HCM. There are other patchy areas of midmyocardial enhancement along the septum (short arrow in E). (F) Spatial enhancement analysis shows 5% of total enhanced myocardial volume.