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{{Hypertrophic cardiomyopathy}}
{{Hypertrophic cardiomyopathy}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{Soroush}}


==Overview==
==Overview==
There are no other imaging findings associated with Hypertrophic cardiomyopathy.
[[Positron emission tomography|Positron Emission Tomography]] ([[PET]]) may be helpful in the diagnosis of [[ischemia]] in patients with hypertrophic cardiomyopathy. [[PET]] studies have demonstrated that coronary flow reserve is reduced in patients with HCM. Those patients who subsequently died had a greater reduction in [[coronary]] flow reserve at baseline. It has been hypothesized that this [[ischemia]] may mediate in part the higher risk in [[sudden cardiac death]].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of Hypertrophic cardiomyopathy. Findings on an [imaging modality] suggestive of/diagnostic of Hypertrophic cardiomyopathy include [finding 1], [finding 2], and [finding 3].


==Other Imaging Findings==
==Other Imaging Findings==
There are no other imaging findings associated with Hypertrophic cardiomyopathy.
[[Positron emission tomography|Positron Emission Tomography]] ([[PET]]) may be helpful in the [[diagnosis]] of [[ischemia]] in patients with hypertrophic cardiomyopathy.
==Positron Emission Tomography==
[[Positron emission tomography|Positron Emission Tomography]] ([[PET]]) studies have demonstrated that [[coronary flow reserve]] is reduced in patients with HCM. Those patients who subsequently died had a greater reduction in [[coronary flow reserve]] at baseline. It has been hypothesized that this [[ischemia]] may mediate in part the higher risk in [[sudden cardiac death]].


OR
== 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy A Report of the American College of Cardiology/American Heart  Association Joint Committee on Clinical Practice Guidelines<ref name="pmid332159312">{{cite journal| author=Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P | display-authors=etal| title=2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2020 | volume= 142 | issue= 25 | pages= e558-e631 | pmid=33215931 | doi=10.1161/CIR.0000000000000937 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33215931  }}</ref> ==


[Imaging modality] may be helpful in the diagnosis of Hypertrophic cardiomyopathy. Findings on an [imaging modality] suggestive of/diagnostic of Hypertrophic cardiomyopathy include:
=== Recommendations for Angiography and Invasive Hemodynamic Assessment Referenced studies that support the recommendations are summarized in the Online Data Supplement ===
*[Finding 1]
{| class="wikitable"
*[Finding 2]
|-
*[Finding 3]
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
==Cardiac Cathetererization==
|-
[[Left heart catheterization]] can be a useful diagnostic study to ascertain the severity of the dynamic outflow obstruction and its location.
| bgcolor="LightGreen" |1. For patients with HCM who are candidates for SRT and for whom there is uncertainty regarding the presence or severity of LVOTO on noninvasive imaging studies, invasive hemodynamic assessment with cardiac catheterization is recommended''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''
2. In patients with HCM with symptoms or evidence of myocardial ischemia, coronary angiography (CT or invasive) is recommended.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''
3. In patients with HCM who are at risk of coronary atherosclerosis, coronary angiography (CT or invasive) is recommended before surgical myectomy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''
|}


==Left Heart Catheterization==
==2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)<ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>==
Upon [[cardiac catheterization]], [[catheter]]s can be placed in the left ventricle and the ascending [[aorta]], to measure the pressure difference between these structures. In normal individuals, during ventricular [[systole]], the pressure in the ascending aorta and the left ventricle will equalize, and the aortic valve is open. In individuals with [[aortic stenosis]] or with HCM with an outflow tract gradient, there will be a pressure gradient (difference) between the left ventricle and the aorta, with the left ventricular pressure higher than the aortic pressure. This gradient represents the degree of obstruction that has to be overcome in order to eject blood from the left ventricle.


The '''Brockenbrough–Braunwald–Morrow sign''' is observed in individuals with HCM with outflow tract gradient. This sign can be used to differentiate HCM from aortic stenosis. In individuals with aortic stenosis, after a [[premature ventricular contraction]] (PVC), the following ventricular contraction will be more forceful, and the pressure generated in the left ventricle will be higher. Because of the fixed obstruction that the stenotic aortic valve represents, the post-PVC ascending aortic pressure will increase as well. In individuals with HCM, however, the degree of obstruction will increase more than the force of contraction will increase in the post-PVC beat. The result of this is that the left ventricular pressure increases and the ascending aortic pressure ''decreases'', with an increase in the LVOT gradient.
===Detection of Concomitant Coronary Disease (DO NOT EDIT)<ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>===


[[Image:Hypertrophic_Cardiomyopathy_-_Intraventricular_Pressure_Tracing.png|thumb|400px|center|Pressure tracings demonstrating the Brockenbrough–Braunwald–Morrow sign<br><small>AO = Descending aorta; LV = Left ventricle; ECG = Electrocardiogram.<br>After the third [[electrocardiogram|QRS complex]], the ventricle has more time to fill. Since there is more time to fill, the left ventricle will have more volume at the end of [[diastole]] (increased [[Preload (cardiology)|preload]]). Due to the [[Frank-Starling law of the heart|Frank–Starling law of the heart]], the contraction of the left ventricle (and pressure generated by the left ventricle) will be greater on the subsequent beat (beat #4 in this picture). Because of the dynamic nature of the outflow obstruction in HCM, the obstruction increases ''more'' that the left ventricular pressure increase. This causes a fall in the aortic pressure as the left ventricular pressure rises (seen as the yellow shaded area in the picture).<br></small>]]
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Coronary arteriography (invasive or computed tomographic imaging) is indicated in patients with [[HOCM]] with [[chest discomfort]] who have an [[Chronic stable angina risk assessment in patients with an intermediate or high probability of coronary artery disease|intermediate to high likelihood of CAD]] when the identification of concomitant [[CAD]] will change management strategies. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}


While the Brockenbrough–Braunwald–Morrow sign is most dramatically demonstrated using simultaneous intra-cardiac and intra-aortic catheters, it can be seen on routine physical examination as a decrease in the pulse pressure in the post-PVC beat in individuals with HCM.
{|class="wikitable"
 
|-
==Coronary Angiography==
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
Among patients who have [[chest discomfort]] or an [[anginal equivalent]], [[coronary angiography]] carries a class I recommendation to evaluate for the presence of obstructive [[coronary artery disease]].
|-
 
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Assessment of [[ischemia]] or perfusion abnormalities suggestive of [[CAD]] with [[Chronic stable angina myocardial perfusion scintigraphy|single photon emission computed tomography (SPECT)]] or [[Chronic stable angina positron emission tomography (PET)|positron emission tomography (PET)]] myocardial perfusion imaging (MPI; because of excellent negative predictive value) is reasonable in patients with [[HOCM|HCM]] with [[chest discomfort]] and a [[Chronic stable angina assessing the pretest probability of coronary artery disease#Calculating the pretest probability for coronary artery disease|low likelihood of CAD]] to rule out possible concomitant [[CAD]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
===Detection of Concomitant Coronary Disease (DO NOT EDIT)<ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>===
|}


{|class="wikitable"
{|class="wikitable"
|-
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Assessment for the presence of blunted flow reserve ([[ischemia|microvascular ischemia]]) using quantitative myocardial blood flow measurements by [[Chronic stable angina positron emission tomography (PET)|PET]] is not indicated for the assessment of prognosis in patients with [[HOCM|HCM]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Coronary arteriography (invasive or computed tomographic imaging) is indicated in patients with [[HOCM|HCM]] with [[chest discomfort]] who have an [[Chronic stable angina risk assessment in patients with an intermediate or high probability of coronary artery disease|intermediate to high likelihood of CAD]] when the identification of concomitant [[CAD]] will change management strategies. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Routine [[Chronic stable angina myocardial perfusion scintigraphy|SPECT MPI]] or [[Exercise stress testing#Exercise/Pharmacologic Stress Echocardiography|stress echocardiography]] is not indicated for detection of '''silent''' [[CAD|CAD-related ischemia]] in patients with [[HOCM|HCM]] who are asymptomatic. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 18:23, 9 December 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Positron Emission Tomography (PET) may be helpful in the diagnosis of ischemia in patients with hypertrophic cardiomyopathy. PET studies have demonstrated that coronary flow reserve is reduced in patients with HCM. Those patients who subsequently died had a greater reduction in coronary flow reserve at baseline. It has been hypothesized that this ischemia may mediate in part the higher risk in sudden cardiac death.

Other Imaging Findings

Positron Emission Tomography (PET) may be helpful in the diagnosis of ischemia in patients with hypertrophic cardiomyopathy.

Positron Emission Tomography

Positron Emission Tomography (PET) studies have demonstrated that coronary flow reserve is reduced in patients with HCM. Those patients who subsequently died had a greater reduction in coronary flow reserve at baseline. It has been hypothesized that this ischemia may mediate in part the higher risk in sudden cardiac death.

2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy A Report of the American College of Cardiology/American Heart  Association Joint Committee on Clinical Practice Guidelines[1]

Recommendations for Angiography and Invasive Hemodynamic Assessment Referenced studies that support the recommendations are summarized in the Online Data Supplement

Class I
1. For patients with HCM who are candidates for SRT and for whom there is uncertainty regarding the presence or severity of LVOTO on noninvasive imaging studies, invasive hemodynamic assessment with cardiac catheterization is recommended(Level of Evidence: B-NR)

2. In patients with HCM with symptoms or evidence of myocardial ischemia, coronary angiography (CT or invasive) is recommended.(Level of Evidence: B-NR) 3. In patients with HCM who are at risk of coronary atherosclerosis, coronary angiography (CT or invasive) is recommended before surgical myectomy.(Level of Evidence: B-NR)

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)[2]

Detection of Concomitant Coronary Disease (DO NOT EDIT)[2]

Class I
"1. Coronary arteriography (invasive or computed tomographic imaging) is indicated in patients with HOCM with chest discomfort who have an intermediate to high likelihood of CAD when the identification of concomitant CAD will change management strategies. (Level of Evidence: C) "
Class IIa
"1. Assessment of ischemia or perfusion abnormalities suggestive of CAD with single photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial perfusion imaging (MPI; because of excellent negative predictive value) is reasonable in patients with HCM with chest discomfort and a low likelihood of CAD to rule out possible concomitant CAD. (Level of Evidence: C) "
Class III (No Benefit)
"1. Assessment for the presence of blunted flow reserve (microvascular ischemia) using quantitative myocardial blood flow measurements by PET is not indicated for the assessment of prognosis in patients with HCM. (Level of Evidence: C) "
"2. Routine SPECT MPI or stress echocardiography is not indicated for detection of silent CAD-related ischemia in patients with HCM who are asymptomatic. (Level of Evidence: C) "


References

  1. ↑ Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P; et al. (2020). "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 142 (25): e558–e631. doi:10.1161/CIR.0000000000000937. PMID 33215931 Check |pmid= value (help).
  2. ↑ 2.0 2.1 Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 58 (25): e212–60. doi:10.1016/j.jacc.2011.06.011. PMID 22075469. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
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