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World J Cardiol. Aug 26, 2014; 6(8): 764-770
Published online Aug 26, 2014. doi: 10.4330/wjc.v6.i8.764
Hypertrophic cardiomyopathy: Can the noninvasive diagnostic testing identify high risk patients?
Li Zhang, Obinna Mmagu, Liwen Liu, Dayuan Li, Yuxin Fan, Adrian Baranchuk, Peter R Kowey
Li Zhang, Obinna Mmagu, Peter R Kowey, Center for Clinical Cardiology, Lankenau Institute for Medical Research, Lankenau Medical Center, Jefferson Medical College, Philadelphia, PA 19096, United States
Liwen Liu, Department of Ultrasound, Xijing Hospital, Forth Military Medical University, Xi’an 710032, Shaanxi Province, China
Dayuan Li, HeartEast Heart Care, HealthEast Care System, St. Paul, MN 55102, United States
Yuxin Fan, John Welsh Cardiovascular Diagnostic Laboratory, Department of Pediatrics-Cardiology, Baylor College of Medicine, Houston, TX 77030, United States
Adrian Baranchuk, Arrhythmia Service, Kingston General Hospital, Queen’s University, K7L 2V7, Ontario, Canada
Author contributions: Zhang L, Mmagu O, Liu L, Li D and Fan Y performed literature search and contributed in manuscript writing; Baranchuk A and Kowey PR performed manuscript editing.
Supported by W.W. Smith Charitable Trust
Correspondence to: Li Zhang, MD, Associate Professor, Center for Clinical Cardiology, Lankenau Institute for Medical Research, Lankenau Medical Center, Jefferson Medical College, R129A, 100 Lancaster Avenue, Wynnewood, PA 19008, United States. ldlzhang@gmail.com
Telephone: +1-484-4762694 Fax: +1-484-4761658
Received: February 12, 2014
Revised: April 29, 2014
Accepted: May 28, 2014
Published online: August 26, 2014
Processing time: 217 Days and 1.3 Hours
Abstract

Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in the young, particularly among athletes. Identifying high risk individuals is very important for SCD prevention. The purpose of this review is to stress that noninvasive diagnostic testing is important for risk assessment. Extreme left ventricular hypertrophy and documented ventricular tachycardia and fibrillation increase the risk of SCD. Fragmented QRS and T wave inversion in multiple leads are more common in high risk patients. Cardiac magnetic resonance imaging provides complete visualization of the left ventricular chamber, allowing precise localization of the distribution of hypertrophy and measurement of wall thickness and cardiac mass. Moreover, with late gadolinium enhancement, patchy myocardial fibrosis within the area of hypertrophy can be detected, which is also helpful in risk stratification. Genetic testing is encouraged in all cases, especially in those with a family history of HCM and SCD.

Keywords: Hypertrophic cardiomyopathy; Sudden cardiac death; Noninvasive diagnostic testing

Core tip: Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in the young, particularly among athletes. Noninvasive diagnostic testing is important for risk assessment. Extreme left ventricular hypertrophy, documented ventricular tachycardia and fibrillation increase the risk of SCD. Fragmented QRS complex and T wave inversion in multiple leads are more common in high risk patients. Cardiac magnetic resonance imaging with late gadolinium enhancement, patchy myocardial fibrosis within the area of hypertrophy can be detected, which is also helpful in risk stratification. Genetic testing is encouraged in all cases, especially in those with family history of HCM and SCD.