Cardiovascular computed tomography in the preoperative diagnosis of hypertrophic cardiomyopathy.

Backgraund: A comprehensive approach of hypertrophic cardiomyopathy (HCM) imaging will ensure high-quality control and effective surgical treatment of patients with HCM. Innovative computed technologies introduction to study diverse collection of phenotypes in combination with mitral valve (MV) abnormalities and myocardial structure is becoming relevant and promising. Aims: to evaluate the possibilities of computed tomography of various HCM phenotypes in the preoperative stage. Materials and methods: included retrospective data of 47 patients with HCM (mean ages 52±7 y.o.). CT imaging were applied using our protocol with bolus-tracking on the left atrium and 90HU threshold, biphasic contrast injection for the assessment of heart and coronary arteries anatomy and MV morphology. Additionally the data on iodine DECT maps of left ventricle were analyzed to estimate myocardial structure anomalies. All patients were classified into morphological types according to the anatomical principle. Results: In our publication a various HCM were demonstrated, subdivided into 5 morphological phenotypes. 26 (55%) patients had diffuse septum HCM, 5(11%) midventricular HCM, and 2 (40%) of them midventricular with apex dilatation; 8 (18%) patients had focal basal septum HCM; 4 (8%) with concentric and diffuse HCM, and 4 (8%) with apical HCM. The majority of patients were diagnosed with papillary muscles abnormalities, divided into abnormalities of the number and position, as well as the ratio of chords and muscles. In 10 (21%) patients were obtained myocardial bridge of coronary artery, 3 (14%) of them with dynamic stenosis. Focal iodine enhancement was seen in all cases on DECT. ECV elevation was observed in 10/13 (76%) patients. Average ECV/DECT value was 30,58% (95% CI 27–34%). Conclusions: Adequate computed tomography technology and a dedicated acquisition protocol are needed for HCM morphological types estimation, detail anatomic left ventricle function analysis, geometry and mitral valve changes, state of the coronary bed assessment and myocardial fibrosis evaluation.