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Archives of cardiovascular diseases
Volume 104, n° 12
pages 682-683 (décembre 2011)
Doi : 10.1016/j.acvd.2011.03.092
Received : 12 August 2010 ;  accepted : 31 Mars 2011
Potential value of myocardial contrast echocardiography for the detection of myocardial fibrosis in hypertrophic cardiomyopathy
Intérêt de l’échocardiographie de contraste pour le diagnostic de fibrose myocardique dans la cardiomyopathie hypertrophique
 

Aurélie Chaudeurge , Philippe Garçon, Romain Cador
Cardiology Department, Fondation hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France 

Corresponding author.

Keywords : Contrast echocardiography, Magnetic resonance imaging, Myocardial fibrosis, Hypertrophic cardiomyopathy

Mots clés : Échocardiographie de contraste, Imagerie par résonance magnétique, Fibrose myocardique, Cardiomyopathie hypertrophique

Abbreviations : LVH, MRI


We report the case of a 37-year-old man with hypertrophic cardiomyopathy. Echocardiography showed a left ventricular hypertrophy (LVH) on the septal area (25mm), without intraventricular obstruction or systolic anterior motion of the mitral valve. Myocardial contrast echocardiography showed an unusual capture of the contrast in the anteroseptal wall of the left ventricle, 5minutes after injection of Sonovue® (Bracco Diagnostics, Inc., Princeton, NJ, USA; Figure 1).



Figure 1


Figure 1. 

Myocardial contrast echocardiography showing (arrows) unusual capture of contrast in the anteroseptal wall of the left ventricle, 5minutes after injection.

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Two weeks later, magnetic resonance imaging (MRI) was performed to confirm the LVH predominantly on the septal area (25mm). Myocardial mass was 335g. Delayed enhancement MRI studies (10minutes after gadolinium injection) showed a delay-enhancement on the septal wall of the left ventricle, with an excellent topographic match with the abnormal contrast retention seen on echocardiography. The late enhancement was patchy and located predominantly in the subendocardium and not in the intramyocardium, which is more usual in LVH (Figure 2). To rule out ischaemic cardiopathy, cardiac computed tomography was performed, which was normal.



Figure 2


Figure 2. 

MRI showing delay-enhancement (arrows) on the septal wall of the left ventricle, with an excellent topographic match with the abnormal contrast retention seen on echocardiography. The late enhancement was patchy and located predominantly in the subendocardium.

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Delayed enhancement MRI studies can show late myocardial enhancement in hypertrophic cardiomyopathy, especially on the septal wall, corresponding to fibrosis. Although the use of delayed enhancement MRI in the diagnosis of myocardial fibrosis has been well documented in the literature, similar contrast enhancement areas seen on a contrast echocardiography and compared with MRI have not been reported. Late enhancement of microbubbles with myocardial echocardiography has already been used in the detection and quantification of myocardial infarct scars.

We believe that contrast echocardiography may have potential value for the detection of myocardial fibrosis in LVH.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.



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