Ventricular arrhythmias in apical hypertrophic cardiomyopathy: association with late gadolinium enhancement

Methods 26 consecutive patients (pts), aged 38 ± 11 years-old, 15 men, with AHCM, were included. Diagnosis was established by CMR using accepted criteria All underwent complete CMR LV assessment using a 17-segments model: a) SSFP short-axis LV volumes and ejection fraction; b) SSFP 2, 3, 4-chambers for thickness measurement; c) LV segmental LGE (segmented inversion-recovery fast gradientecho sequence, 10-15 mn after 0.2 mmol/kg of Gd-DTP); the presence and amount of LGE was assessed. A 24 hours-Holter monitoring was obtained in less than twoweeks interval and the number of repetitive ventricular arrhythmias was assessed (pairs, triplets, ventricular tachycardia). Results Maximal apical thickness was 21 ± 4 mm (13-30), left ventricular end-diastolic volume was 56 ± 8 ml/m2 (39-73) and ejection fraction was 68 ± 5% (59-80). LGE was detected in 15 pts, localized at the midwall apical region, filling all this segment in 12 pts and nodular in the remaining three. No hypertrophy or LGE was detected in other LV segments. The presence of repetitive ventricular arrhythmias was significantly different in patients with and without LGE (p = 0.0001). Patients with LGE, showed 10 to 143 repetitive episodes in the Holter monitoring. There was no correlation between the number of ventricular arrhythmias and the amount of LGE (LGE volume/ hypertrophied apical segment volume), the apical thickness, LV volume or ejection fraction.