HCM is characterised by thickening of the muscular wall of the left ventricle. Most commonly the thickening is in the septal wall. However, sometimes it can be in other areas, particularly the tip (apex) of the heart.
The apex is sometimes difficult to see using echocardiography. The cine images from CMR show the apex of the heart in great detail allowing assessment of whether there is thickening of the muscle or any complications resulting from it.
Some patients with HCM develop obstruction to blood getting out of the heart which can cause them symptoms. This can be treated in different ways.
To decide what is likely to work best, it is important to have high quality images showing the precise anatomy of the heart. Often the images from an echocardiogram are more than adequate for this, but in some patients CMR is used to see detail.
Lastly, the imaging of scar in HCM is important. Research has shown that patients with a lot of scar are more likely to develop worsening pump function.
This information will become even more important if specific therapies are developed to prevent this from occurring.
There are some rare conditions that can appear very similar to HCM in the way they show themselves because they also cause thickening of the heart muscle. It is important to distinguish these from HCM as the treatment is often different.
In older patients one cause of this is amyloidosis. This is a condition where proteins are laid down in the heart muscle, making it appear thicker on imaging. The scar pattern it causes on CMR is unique and very different to HCM. A finding of this unusual scar pattern will prompt referral to an amyloidosis expert for further assessment.
Another rare HCM mimic is a genetic condition called Anderson Fabry disease. Many centres routinely perform blood tests on patients with HCM to ensure they do not have this problem, but on CMR it can cause a type of scar pattern that we do not often see in HCM otherwise. This finding would ensure the patient was tested for the disease.
The apex is sometimes difficult to see using echocardiography. The cine images from CMR show the apex of the heart in great detail allowing assessment of whether there is thickening of the muscle or any complications resulting from it.
Some patients with HCM develop obstruction to blood getting out of the heart which can cause them symptoms. This can be treated in different ways.
To decide what is likely to work best, it is important to have high quality images showing the precise anatomy of the heart. Often the images from an echocardiogram are more than adequate for this, but in some patients CMR is used to see detail.
Lastly, the imaging of scar in HCM is important. Research has shown that patients with a lot of scar are more likely to develop worsening pump function.
This information will become even more important if specific therapies are developed to prevent this from occurring.
There are some rare conditions that can appear very similar to HCM in the way they show themselves because they also cause thickening of the heart muscle. It is important to distinguish these from HCM as the treatment is often different.
In older patients one cause of this is amyloidosis. This is a condition where proteins are laid down in the heart muscle, making it appear thicker on imaging. The scar pattern it causes on CMR is unique and very different to HCM. A finding of this unusual scar pattern will prompt referral to an amyloidosis expert for further assessment.
Another rare HCM mimic is a genetic condition called Anderson Fabry disease. Many centres routinely perform blood tests on patients with HCM to ensure they do not have this problem, but on CMR it can cause a type of scar pattern that we do not often see in HCM otherwise. This finding would ensure the patient was tested for the disease.
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