Diagnostic capabilities of cardiac computed tomography in the preoperative diagnosis of hypertrophic cardiomyopathy

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BACKGROUND: A comprehensive approach to studying hypertrophic cardiomyopathy with diagnostic equipment and the latest scanning methods will ensure quality control and effective treatment of patients with this condition. The implementation of innovative technologies and computer calculation using next-generation scanners may become relevant and promising in studying various phenotypes of left ventricular remodeling in combination with abnormalities of the chordopapillary apparatus of the mitral valve and myocardial structure.

AIM: To examine the diagnostic capabilities of computed tomography in the preoperative examination of various hypertrophic cardiomyopathy phenotypes.

MATERIALS AND METHODS: The retrospective data analysis included 47 patients with hypertrophic cardiomyopathy (mean age, 52±7 full years) before surgical correction. computed tomography was performed using our protocol with automatic bolus tracking in the left atrium with a 90 HU threshold and biphasic contrast injection to assess the heart chambers and coronary arteries anatomy and mitral valve morphology. Moreover, to assess myocardial structure remodeling, iodine dual-energy computed tomography maps obtained with delayed contrast enhancement were analyzed. All patients with hypertrophic cardiomyopathy were classified by morphological types. The anatomy of chordopapillary apparatus was evaluated in each case.

RESULTS: This study demonstrated variability in hypertrophic cardiomyopathy phenotypes, which were conventionally divided into five morphological categories, but not restricted by them. Among the patients, 26 (55%) had diffuse septum hypertrophic cardiomyopathy, 5 (11%) had midventricular hypertrophic cardiomyopathy, 2 (4%) had midventricular obstruction and apical aneurysm, 8 (18%) had focal basal septum hypertrophic cardiomyopathy, 4 (8%) had concentric hypertrophic cardiomyopathy, and the remaining 4 (8%) had apical hypertrophic cardiomyopathy. Most patients were diagnosed with chordopapillary abnormalities of the mitral valve, categorized by papillary muscle number and position, and the ratio of chords to muscles. In 10 (21%) patients, data on the myocardial bridge of a coronary artery were obtained, whereas 3 (14%) of them had dynamic stenosis. All patients had focal iodine uptake on dual-energy computed tomography maps. An extracellular volume increase was observed in 10 out of 13 (76%) patients. As shown by dual-energy computed tomography, the mean extracellular volume of the left ventricular myocardium was 30.58% (95% confidence interval, 27–34%).

CONCLUSION: Our scanning protocols developed with computed tomography scanners of various generations enable to evaluate the specific morphological patterns of hypertrophic cardiomyopathy in a single study and provide a detailed interpretation of the geometry of cardiac valves and chambers, left ventricular function, state of the coronary bed, and structural changes of the left ventricular myocardium.

Sobre autores

Olga Dariy

Bakulev Scientific Center for Cardiovascular Surgery; Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: dariiolyka@mail.ru
ORCID ID: 0000-0003-0140-8166
Código SPIN: 1844-4944

MD, Cand. Sci. (Medicine)

Rússia, Moscow; Moscow

Liudmila Yurpolskaya

Bakulev Scientific Center for Cardiovascular Surgery

Email: layurpolskaya@bakulev.ru
ORCID ID: 0000-0001-7780-2405
Código SPIN: 8436-9665

MD, Dr. Sci. (Medicine)

Rússia, Moscow

Inna Rychina

Bakulev Scientific Center for Cardiovascular Surgery

Email: ierychina@bakulev.ru
ORCID ID: 0000-0001-8056-4188
Código SPIN: 3516-0729

MD, Cand. Sci. (Medicine)

Rússia, Moscow

Aleksey Dorofeev

Bakulev Scientific Center for Cardiovascular Surgery

Email: avdorofeev@bakulev.ru
ORCID ID: 0000-0003-0833-9650

MD, Cand. Sci. (Medicine)

Rússia, Moscow

Elena Golukhova

Bakulev Scientific Center for Cardiovascular Surgery

Autor responsável pela correspondência
Email: egolukhova@bakulev.ru
ORCID ID: 0000-0002-6252-0322
Código SPIN: 9334-5672

MD, Dr. Sci. (Medicine), Academician of Russian Academy of Science

Rússia, Moscow

Bibliografia

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2. Fig. 1. Image of pre-monitoring computed tomography and monitoring graph: a — setting for automatic monitoring of contrast agent bolus in the left atrium with a bolus threshold of 90 HU; b — example of contrast agent bolus monitoring graph.

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3. Fig. 2. An example of post-processing of images of computed tomography of the heart of a patient with hypertrophic cardiomyopathy. Visualization of the cavities of the heart, coronary arteries and heads of the papillary muscles: a — 3D reconstruction of the four-chamber projection of the heart; b — 3D reconstruction of the coronary arteries; c — multiplanar reconstruction in the two-chamber projection of the heart. LA — left atrium, LV — left ventricle, RA — right atrium, RV — right ventricle.

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4. Fig. 3. Iodine maps of dual-energy computed tomography: a — four-chamber projection of the heart (ROI — measurement of iodine distribution in the left ventricular cavity and interventricular septum); b — short axis of the heart (ROI — measurement of iodine distribution in the left ventricular cavity and along the interventricular septum).

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5. Fig. 4. Example of 3D images of computed tomography of the diffuse-septal phenotype of HCM: a — plane of the two-chamber projection of the left heart; b — short axis of the heart; c — four-chamber projection of the heart. LV — left ventricle, LA — left atrium, RV — right ventricle, RA — right atrium.

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6. Fig. 5. Example of MPR and 3D CT images of the midventricular phenotype of hypertrophic cardiomyopathy with signs of systolic cavity obstruction due to a variant anomaly of the chordopapillary apparatus and asymmetric hypertrophy of the left ventricular myocardium: a - plane of the two-chamber projection of the left heart; b - three-chamber projection of the heart; c - four-chamber projection of the heart. Apical displacement of the posterolateral papillary muscle and direct contact with the anterior leaflet of the mitral valve; splitting of the papillary muscle legs + accessory muscular trabecula.

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7. Fig. 6. Example of 3D-images of computed tomography of the focal-basal phenotype of hypertrophic cardiomyopathy: a — plane of two-chamber projection of the left heart; b — short axis of the heart. LV — left ventricle; LA — left atrium; RV — right ventricle; IVS — interventricular septum; Ao — aorta.

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8. Fig. 7. Example of MPR and 3D CT images of a patient with the apical phenotype of hypertrophic cardiomyopathy after implantation of a cardioverter-defibrillator: a — plane of the four-chamber projection; b — two-chamber projection of the left heart; c — 3D VRT reconstruction of the four-chamber projection of the heart.

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9. Fig. 8. An example of visual assessment of focal iodine accumulation in segments of the myocardium of the th ventricle based on the iodine map of dual-energy computed tomography: a — short axis of the heart; b — axial projection of the heart.

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