Introduction
Pressure overload | Hypertension Aortic stenosis Coarctation Subaortic membrane |
Volume overload | Aortic/mitral regurgitation Dilated cardiomyopathy |
Infiltrative cardiomyopathies | Amyloidosis Anderson-Fabry disease Danon disease Eosinophilic heart disease Mucopolysaccharidoses Friedreich’s ataxia Myocardial oxalosis Pompe disease Sarcoidosis Iron overload |
Non infiltrative cardiomyopathy | Hypertrophic cardiomyopathy |
Adaptive response | Athlete’s heart |
Miscellaneous | Neoplastic infiltration |
Imaging of left ventricular thickening
Echocardiography
Computed tomography
MRI
MRI parameters in LV thickening
Geometrical patterns of LV thickening
Wall thickness | Septal/lateral wall ratio | LV mass | LV volume | Relative wall mass (LVM/EDV) | Ejection fraction | |
---|---|---|---|---|---|---|
Normal | Normal | Normal | Normal | Normal | Normal | Normal |
Concentric remodeling | Normal | Normal | Normal | Decreased | Increased | Normal |
Asymmetric remodeling | Normal | Increased | Normal | Decreased | Increased | Normal |
Concentric Hypertrophy | Increased | Normal | Increased | Normal/Increased | Increased | Normal/decreased |
Eccentric hypertrophy | Normal | Normal | Increased | Increased | Normal/subnormal | Decreased |
Asymmetric hypertrophy | Increased | Increased | Increased | Normal/decreased | Increased | Normal/increased |
Infiltrative disease | Increased | Normal | Increased | Normal/decreased | Increased | Decreased/normal |
Etiologies of LV thickening
Disease | Role of MRI |
---|---|
General | Establishing the presence of hypertrophy Characterizing the geometry Quantification of volumes, masses and function Establishing aetiology Fibrosis- Prognostic determinant Evaluating regression |
Systemic hypertension | Secondary causes of hypertension- renovascular, adrenal lesion |
Aortic stenosis | Planimetry- Aortic valve area Phase contrast- Quantification of stenosis Fibrosis Evaluation for TAVI |
Coarctation | Identification of coarctation/hypoplasia Quantification of narrowing Collaterals Associated abnormalities |
Subaortic membrane | Membrane- Location, size Quantification of obstruction |
Aortic/mitral regurgitation | Quantification of regurgitation Volume quantification |
Dilated cardiomyopathy | Quantification of volumes Fibrosis |
Amyloidosis | T1 kinetics and T1 mapping- Diagnosis and prognosis Late gadolinium enhancement |
Danon disease | Fibrosis |
Hypertrophic cardiomyopathy | Pattern of HCM Quantification of obstruction Mitral valve abnormalities- SAM, elongated anterior leaflet Papillary muscle abnormalities Fibrosis |
Athlete’s heart | Quantification of volumes Response to deconditioning |
Anderson Fabry disease | T1 mapping allows detection of fibrosis and lipid deposition |
Iron overload cardiomyopathy | Myocardial iron quantification |
Pressure overload
HT
Aortic stenosis
Peak velocity (m/s) | Mean gradient | Valve area | Indexed valve area | Velocity ratio | |
---|---|---|---|---|---|
Mild | 2.6-2.9 | <20a (<30b) mm Hg | <1.5 cm2 | 0.85 cm2/m2 | >0.5 |
Moderate | 3.0-4.0 | 20-40a (30–50 b) mm Hg | 1-1.5 cm2 | 0.60-0.85 cm2/m2 | 0.25-0.5 |
Severe | >4.0 | >40a (50b) mm Hg | <1 cm2 | <0.6 cm2/m2 | <0.25 |