Background

Left ventricular (LV) apical aneurysm is a unique morphological entity and novel adverse risk marker existing within the broad phenotypic spectrum of hypertrophic cardiomyopathy (HCM). Its true prevalence in the HCM population is likely underestimated because of inherent limitations of conventional noncontrast echocardiography. The authors hypothesized that contrast echocardiography is a reliable imaging technique compared with cardiovascular magnetic resonance (CMR) for the detection of apical aneurysms. The aim of this study was to assess the effectiveness of contrast echocardiography in the detection of LV apical aneurysms in patients with HCM in comparison with the gold standard, CMR.

Methods

One hundred twelve patients with HCM identified from an institutional clinical database, who underwent echocardiographic and CMR examinations within 12 months and had LV apical aneurysms identified on either or both imaging modalities, were retrospectively analyzed. Discordant cases were reviewed by an expert panel, and a consensus was reached regarding the presence or absence of an apical aneurysm. The reason for any discrepancy was recorded.

Results

The mean age of the patients was 59 ± 13 years, and 73% were men. Sixty-four (57%) underwent contrast echocardiography. The median interval between echocardiography and CMR was 118 days (interquartile range, 61–237 days). Thirty-nine patients (35%) had discordance between echocardiographic and CMR findings, of whom 20 had aneurysms reported on echocardiography but not CMR and 19 vice versa. Upon reanalysis by the expert panel, aneurysms were initially missed on CMR in 16 patients (80%), largely because of interpretation error secondary to small aneurysms, with a mean aneurysm size of 0.82 ± 0.38 cm in these cases. Before secondary review by the expert panel, contrast echocardiography had sensitivity of 97% compared with 85% for CMR (P = .0198) and 64% for noncontrast echocardiography (P = .0001). After secondary review, contrast echocardiography had sensitivity of 98% compared with 67% for noncontrast echocardiography (P = .0001) and 97% for CMR (P = 1.00).

Conclusions

Contrast echocardiography has high sensitivity for detecting LV apical aneurysms and should be used routinely in the evaluation and risk stratification of patients with HCM.

中文翻译：

---

肥厚型心肌病左室心尖动脉瘤：磁共振成像和超声心动图的等效检测

背景

左心室 (LV) 心尖动脉瘤是肥厚型心肌病 (HCM) 广泛表型谱中存在的独特形态实体和新型不良风险标志物。由于传统非对比超声心动图的固有局限性，它在 HCM 人群中的真实患病率可能被低估了。作者假设，与心血管磁共振 (CMR) 相比，对比超声心动图是一种可靠的成像技术，可用于检测心尖动脉瘤。本研究的目的是评估对比超声心动图与金标准 CMR 相比，在检测 HCM 患者 LV 心尖动脉瘤方面的有效性。

方法

对从机构临床数据库中确定的 12 名 HCM 患者进行了回顾性分析，这些患者在 12 个月内接受了超声心动图和 CMR 检查，并在其中一种或两种成像方式上发现了 LV 心尖动脉瘤。不一致的病例由专家小组审查，并就是否存在心尖动脉瘤达成共识。记录任何差异的原因。

结果

患者的平均年龄为 59 ± 13 岁，其中 73% 为男性。64 人 (57%) 接受了对比超声心动图检查。超声心动图和 CMR 之间的中位间隔为 118 天（四分位距，61-237 天）。39 名患者 (35%) 的超声心动图和 CMR 结果不一致，其中 20 名在超声心动图上报告了动脉瘤，但在 CMR 上没有报告，19 名反之亦然。专家小组重新分析后，最初有 16 名患者 (80%) 的动脉瘤被 CMR 遗漏，主要是由于继发于小动脉瘤的解释错误，这些病例的平均动脉瘤大小为 0.82 ± 0.38 cm。在专家小组二次审查之前，对比超声心动图的敏感性为 97%，而 CMR 的敏感性为 85% ( P  = .0198)，非对比超声心动图的敏感性为64% ( P = .0001）。二次审查后，对比超声心动图的敏感性为 98%，而非对比超声心动图的敏感性为 67% ( P  = .0001)，CMR 的敏感性为97% ( P  = 1.00)。

结论

超声心动图对检测 LV 心尖动脉瘤具有较高的敏感性，应常规用于 HCM 患者的评估和风险分层。