Application of Cardiovascular Computed Tomography to the Assessment of Patients With Hypertrophic Cardiomyopathy

Value of Advanced Cardiac CTA in Clinical Assessment of Hypertrophic Cardiomyopathy: A Literature Review and Practical Implications

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac anomaly with a potentially unfavorable clinical outcome. The essential role of multimodality imaging in HCM is well recognized by major professional cardiac imaging societies and has been incorporated into the HCM clinical practice guidelines. Appropriate utilization of cardiac imaging tools is cardinal for accurate diagnosis and appropriate management for HCM patients to mitigate their lifelong risk of adverse events. Echocardiography is the imaging modality of choice for clinical diagnosis of HCM. Cardiac magnetic resonance (CMR) and coronary computed tomography angiogram (CCTA) offer complementary practical information for an inclusive evaluation in such patients. CCTA provides a thorough analysis of the cardiac anatomy and function that is paramount in HCM clinical decision-making. This review summarizes the utility of CCTA in the clinical assessment of patients with HCM. It outlines the multi-role of CCTA in HCM, including the quantification of cardiac parameters, myocardial tissue characterization, left ventricular (LV) functional analysis, the definition of cardiac and coronary arteries (CA) anatomy, and the provision of a roadmap for septal reduction therapies (SRT), mitral valve (MV) intervention, and atrial fibrillation (AF) ablation.

Scanning the Imaging Horizon for Hypertrophic Cardiomyopathy

In this article some of the recent advances in the use of noninvasive imaging applied to patients with hypertrophic cardiomyopathy (HCM) are discussed. Echocardiography and cardiac computed tomography are briefly discussed with respect to their power to detect apical aneurysmal disease. Echocardiographic phenotype-genotype correlations and the use of echocardiography to characterize myocardial work are reviewed. Positron emission tomography is reviewed in the context of ischemia imaging and also in the context of the use of a new tracer that might allow for recognition of early activation of the fibrosis pathway. Next, the technical capabilities of cardiovascular magnetic resonance to measure myocardial perfusion, oxygenation, and disarray are discussed as they apply to HCM. The application of radiomics to improve prediction of sudden cardiac death is touched upon. Finally, a deep learning approach to the recognition of HCM vs phenocopies is presented as a potential future diagnostic aid in the not-too-distant future.