Abnormalities in T2-weighted cardiovascular magnetic resonance images of hypertrophic cardiomyopathy: regional distribution and relation to late gadolinium enhancement and severity of hypertrophy

Purpose: To explore if focal T2 abnormalities accompany late gadolinium enhancement (LGE) lesions in hypertrophic cardiomyopathy (HCM).

Materials and methods: All studies were performed under the guidelines of the local ethics committee, which approved the study, and a written informed consent was obtained from each subject. We studied 27 patients (24 males, 51 +/- 18 years) with HCM and evidence for myocardial injury as defined by LGE. The following sequences were performed: steady-state free precession (SSFP) (ventricular volumes, mass, and function), T2-weighted triple inversion-recovery spin-echo and inversion-recovery gradient-echo 10 minutes after intravenous (IV) gadolinium-DTPA (late enhancement).

Results: Focal high T2 signal intensity (SI) frequently matching areas of LGE was observed in nine patients (33%). The presence of these abnormalities correlated with more severe left ventricular hypertrophy (1.5 +/- 0.6 vs. 1.0 +/- 0.4 g/cm; P < 0.05).

Conclusion: In this observational study, we identified focal T2 abnormalities in a subgroup of HCM patients. T2 abnormalities are associated with severe left ventricular hypertrophy. This may provide new insights into the mechanisms of focal irreversible injury in HCM and help in managing these patients.