Abstract
Background
The primary mode of imaging in hypertrophic cardiomyopathy (HCM) is transthoracic
echocardiography (TTE). However, in adults inadequate acoustic windows lead to poor
quantification of myocardial thickness compared with cardiac magnetic resonance (CMR)
imaging. In comparison, children have better acoustic windows and TTE measurements
of wall thickness might be more accurate. The aim of this study was to assess the
performance of TTE compared with CMR for the assessment of myocardial thickness in
children with HCM.
Methods
Nineteen children (median age, 12.7 years; range, 8.4-18.4 years) with known HCM were
studied using TTE and CMR imaging on the same day. The left ventricle was measured
off-line using the standard 16-segment model.
Results
With CMR imaging 304 (19 × 16) segments were analyzable whereas only 263 were analyzable
using echocardiography. Wall thickness measurements according to TTE were greater
than those according to CMR imaging in the basal anterolateral, midventricular anterior
and anterolateral and apical inferior, lateral and septal segments and smaller for
the midventricular inferior and inferoseptal segments. Reproducibility of CMR and
TTE measurements was assessed using the intraclass correlation coefficient (ICC).
CMR measurements showed excellent intrareader (ICC, 0.929-0.991) and moderate inter-reader
(ICC range, 0.512-0.991) reproducibility. TTE measurements revealed moderate intrareader
(ICC, 0.575-0.942) and poor inter-reader (ICC range, −1.02 to 0.939) reproducibility.
Conclusions
Echocardiography incompletely assesses circumferential myocardial thickness in a proportion
of pediatric patients with HCM. Echocardiography under- and overestimates maximum
wall thickness compared with CMR, depending on the location. Measurements using CMR
are more reproducible than those obtained using echocardiography.
Résumé
Introduction
Le mode d’imagerie principal de la cardiomyopathie hypertrophique (CMH) est l’échocardiographie
transthoracique (ETT). Toutefois, les fenêtres acoustiques inadéquates chez les adultes
entraînent une mauvaise quantification de l’épaississement du myocarde comparativement
à l’imagerie par résonance magnétique (IRM) cardiaque. Par comparaison, comme les
enfants ont de meilleures fenêtres acoustiques, les mesures de l’ETT de l’épaississement
de la paroi seraient plus précises. L’objectif de la présente étude était d’évaluer
la performance de l’ETT par rapport à celle de l’IRM cardiaque dans l’évaluation de
l’épaississement du myocarde chez les enfants atteints de CMH.
Méthodes
Dix-neuf enfants (âge médian, 12,7 ans; étendue, 8,4-18,4 ans) atteints d’une CMH
connue ont fait l’objet d’une étude au moyen de l’ETT et de l’IRM cardiaque le même
jour. Le ventricule gauche a été mesuré hors ligne à l’aide du modèle habituel à 16
segments.
Résultats
Au moyen de l’IRM cardiaque, 304 (19 × 16) segments ont été analysés tandis que seulement
263 segments étaient analysables au moyen de l’échocardiographie. Les mesures de l’épaississement
de la paroi selon l’ETT étaient plus grandes que celles selon l’IRM cardiaque dans
les segments basaux antérolatéraux, médioventriculaires antérieurs et antérolatéraux
et apicaux inférieurs, latéraux et septaux, et plus petites dans les segments médioventriculaires
inférieurs et inféroseptaux. La reproductibilité des mesures de l’IRM cardiaque et
de l’ETT a été évaluée à l’aide du coefficient de corrélation intraclasse (CCI). Les
mesures de l’IRM cardiaque ont montré une excellente reproductibilité intraobservateur
(CCI, 0,929-0,991) et une reproductibilité interobservateur modérée (étendue du CCI,
0,512-0,991). Les mesures de l’ETT ont révélé une reproductibilité intraobservateur
modérée (CCI, 0,575-0,942) et une reproductibilité interobservateur médiocre (étendue
du CCI, −1,02 à 0,939).
Conclusions
L’échocardiographie évalue de façon incomplète l’épaississement myocardique circonférentiel
chez un certain nombre de patients de pédiatrie atteints de CMH. L’échocardiographie
sous-estime et surestime l’épaississement maximal de la paroi comparativement à l’IRM
cardiaque, selon la localisation. Les mesures au moyen de l’IRM cardiaque sont plus
reproductibles que celles obtenues au moyen de l’échocardiographie.
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Article info
Publication history
Published online: July 14, 2016
Accepted:
June 1,
2016
Received:
May 5,
2015
Footnotes
See page 1511 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
