Cardiovascular Magnetic Resonance for the Differentiation of Left Ventricular Hypertrophy
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IMAGING IN HEART FAILURE (J SCHULZ-MENGER, SECTION EDITOR)
Cardiovascular Magnetic Resonance for the Differentiation of Left Ventricular Hypertrophy Matthew K. Burrage 1 & Vanessa M. Ferreira 1
# The Author(s) 2020
Abstract Purpose of Review Left ventricular hypertrophy (LVH) is a common presentation encountered in clinical practice with a diverse range of potential aetiologies. Differentiation of pathological from physiological hypertrophy can be challenging but is crucial for further management and prognostication. Cardiovascular magnetic resonance (CMR) with advanced myocardial tissue characterisation is a powerful tool that may help to differentiate these aetiologies in the assessment of LVH. Recent Findings The use of CMR for detailed morphological assessment of LVH is well described. More recently, advanced CMR techniques (late gadolinium enhancement, parametric mapping, diffusion tensor imaging, and myocardial strain) have been used. These techniques are highly promising in helping to differentiate key aetiologies of LVH and provide valuable prognostic information. Summary Recent advancements in CMR tissue characterisation, such as parametric mapping, in combination with detailed morphological assessment and late gadolinium enhancement, provide a powerful resource that may help assess and differentiate important causes of LVH. Keywords Left ventricular hypertrophy (LVH) . Cardiovascular magnetic resonance (CMR) . T1 mapping
Introduction Left ventricular hypertrophy (LVH), defined as an increase in LV mass or wall thickness, is commonly encountered in clinical practice and is associated with structural myocardial changes [1]. It independently predicts adverse cardiovascular outcomes in large population-based studies [2–4]. There are multiple causes of LVH, ranging from physiological adaptation to athletic training or increased afterload (such as hypertension or aortic stenosis), to more severe pathological hypertrophy, as seen in hypertrophic cardiomyopathies and infiltrative/storage diseases. Although clinical and family history, along with physical examination, may narrow the differential diagnosis, the exact aetiology can remain unclear. Given that the management and prognosis of different This article is part of the Topical Collection on Imaging in Heart Failure * Vanessa M. Ferreira [email protected] 1
University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
aetiologies of LVH may differ significantly, an accurate diagnosis is crucial. Cardiovascular magnetic resonance (CMR) is the current imaging gold standard for accurate and reproducible assessment of cardiac mass, volumes and function [5–7], and is superior to echocardiography (TTE) in the assessment and differentiation of LVH [5, 8, 9]. Its excellent spatial resolution allows evaluation of cardiac structure and function, as well as the presence, symmetry and distribution of hypertrophy [10]. Although
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