Diffusion tensor cardiac magnetic resonance imaging to measure myocardial disarray in patients with hypertrophic cardiomyopathy
Sudden cardiac death is the most feared complication of Hypertrophic Cardiomyopathy. This inherited heart muscle disease affects 1 in 500 people. But we are poor at identifying those who really need a potentially life-saving implantable cardioverter-defibrillator. Measuring the abnormalities believed to trigger fatal ventricular arrhythmias could guide treatment. Myocardial disarray is the hallmark feature of patients who die suddenly but is currently a post mortem finding. Through recent advances, the microstructure of the myocardium can now be examined by mapping the preferential diffusion of water molecules along fibres using Diffusion Tensor Cardiac Magnetic Resonance imaging. Fractional anisotropy calculated from the diffusion tensor, quantifies the directionality of diffusion. Here, we show that fractional anisotropy demonstrates normal myocardial architecture and provides a novel imaging biomarker of the underlying substrate in hypertrophic cardiomyopathy which relates to ventricular arrhythmia.