In patients with hypertrophic cardiomyopathy (HCM), ischemic myocardial fibrosis assessed by late gadolinium enhancement (I-LGE) using cardiovascular magnetic resonance (CMR) have been reported. However, the clinical significance of I-LGE has not been completely understood. We aim to evaluate the I-LGE differ phenotypically from HCM without LGE or nonischemic myocardial fibrosis assessed by late gadolinium enhancement (NI-LGE) in the left ventricle (LV). The patients with HCM whom was underwent CMR were enrolled, using cine cardiac magnetic resonance to evaluate LV function and LGE to detect the myocardial fibrosis. Three groups were assorted: 1) HCM without LGE; 2) HCM with LGE involved the subendocardial layer was defined as I-LGE; 3) HCM with LGE not involved the subendocardial layer was defined as NI-LGE. We enrolled 122 patients with HCM in the present study. LGE was detected in 58 of 122 (48%) patients with HCM, and 22 (18%) of patients reported I-LGE. HCM with I-LGE had increased higher left ventricular mass index (LVMI) (P < 0.0001) than HCM with NI-LGE or without LGE. In addition, HCM with I-LGE had a larger LV end- systolic volume (P = 0.045), lower LV ejection fraction (LVEF) (P = 0.026), higher LV myocardial mass (P < 0.001) and thicker LV wall (P < 0.001) more than HCM without LGE alone. The I-LGE were significantly associated with LVEF (OR: 0.961; P = 0.016), LV mass (OR: 1.028; P < 0.001), and maximal end-diastolic LVWT (OR: 1.567; P < 0.001). On multivariate analysis, LVEF (OR: 0.948; P = 0.013) and maximal end-diastolic LVWT (OR: 1.548; P = 0.001) were associated with higher risk for I-LGE compared to HCM without LGE. Noticeably, the maximal end-diastolic LVWT (OR: 1.316; P = 0.011) was the only associated with NI-LGE compared to HCM without LGE. I-LGE is not uncommon in patients with HCM. HCM with I-LGE was associated with significant LV hypertrophy, extensive LGE and poor LV ejection fraction. We should consider focal ischemic myocardial fibrosis when applying LGE to risk stratification for HCM.

中文翻译：

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晚期钆增强心血管磁共振评估肥厚型心肌病患者局灶性缺血性心肌纤维化

据报道，在肥厚型心肌病 (HCM) 患者中，使用心血管磁共振 (CMR) 通过晚期钆增强 (I-LGE) 评估缺血性心肌纤维化。然而，I-LGE 的临床意义尚未完全了解。我们的目的是评估 I-LGE 与无 LGE 的 HCM 的表型差异，或通过左心室 (LV) 的晚期钆增强 (NI-LGE) 评估的非缺血性心肌纤维化。入组接受CMR的HCM患者，采用电影心脏磁共振评估左室功能，LGE检测心肌纤维化情况。分为三组：1）没有 LGE 的 HCM； 2）累及心内膜下层伴LGE的HCM定义为I-LGE； 3)不累及心内膜下层的伴有LGE的HCM定义为NI-LGE。我们在本研究中招募了 122 名 HCM 患者。 122 名 HCM 患者中，有 58 名 (48%) 检测到 LGE，其中 22 名 (18%) 患者报告 I-LGE。具有 I-LGE 的 HCM 比具有 NI-LGE 或不具有 LGE 的 HCM 增加了更高的左心室质量指数 (LVMI) (P < 0.0001)。此外，伴有 I-LGE 的 HCM 具有较大的 LV 收缩末期容积 (P = 0.045)、较低的 LV 射血分数 (LVEF) (P = 0.026)、较高的 LV 心肌质量 (P < 0.001) 和较厚的 LV 壁 (P < 0.001) 比没有单独使用 LGE 的 HCM 更高。 I-LGE 与 LVEF（OR：0.961；P = 0.016）、LV 质量（OR：1.028；P < 0.001）和最大舒张末期 LVWT（OR：1.567；P < 0.001）显着相关。多变量分析显示，与无 LGE 的 HCM 相比，LVEF（OR：0.948；P = 0.013）和最大舒张末期 LVWT（OR：1.548；P = 0.001）与 I-LGE 的风险较高相关。值得注意的是，与没有 LGE 的 HCM 相比，最大舒张末期 LVWT（OR：1.316；P = 0.011）是唯一与 NI-LGE 相关的。 I-LGE 在 HCM 患者中并不罕见。伴有 I-LGE 的 HCM 与明显的左室肥厚、广泛的 LGE 和左室射血分数差相关。应用LGE对HCM进行危险分层时应考虑局灶性缺血性心肌纤维化。