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Cardiovascular Images

Extensive Myocardial Fibrosis in a Patient With Hypertrophic Cardiomyopathy and Ventricular Tachycardia Without Traditional High-Risk Features

Sergio Bongioanni, MD; Paolo Spirito, MD; Andrea Sibona Masi, MD; Amedeo Chiribiri, MD; Rodolfo Bonamini, MD and Maria Rosa Conte, MD

From the Ospedale degli Infermi (S.B., A.S.M., M.R.C.), Rivoli, Torino, Italy; Ente Ospedaliero Ospedali Galliera (P.S.), Genova, Italy; and Ospedale Molinette (A.C., R.B.), Torino, Italy.

Correspondence to Sergio Bongioanni, MD, Ospedale degli Infermi, Strada Rivalta 47, 10098, Rivoli, Torino, Italy. E-mail sergio.bongioanni@virgilio.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Although patients with hypertrophic cardiomyopathy (HCM) and without conventional risk factors for sudden death are generally considered at low risk, the magnitude of risk in such patients remains unknown, and additional markers of prognosis may permit more accurate risk stratification.^1–3 We report a patient with HCM and without conventional risk factors who had a sustained life-threatening ventricular tachyarrhythmia 6 months after identification of extensive myocardial fibrosis at contrast-enhanced cardiovascular magnetic resonance (CMR).

	Case Description

 
A 61-year-old asymptomatic patient with HCM had been followed at our institution for 12 years. The patient had none of the conventional risk factors for sudden death. There was no family history of premature HCM-related sudden death, unexplained syncope, or abnormal blood pressure response during exercise. No episode of nonsustained ventricular tachycardia (3 beat run) had been documented in any of the 6 ambulatory Holter ECGs recorded during follow-up. The echocardiogram showed a nondilated and hypertrophied left ventricle (LV) with a maximal LV wall thickness of 22 mm at the level of the anterior septum, which had remained unchanged since initial evaluation. The LV outflow gradient was 35 mm Hg at rest. The patient was treated with 50 mg/d atenolol. Recently, a contrast-enhanced CMR was performed as part of routine clinical evaluation. After gadolinium infusion, multiple and extensive areas of myocardial late enhancement were demonstrated, involving 80% of the septum and 45% of the free wall (Figure 1). Six months after CMR, the patient was admitted to our emergency department for intense palpitations associated with . . . [Full Text of this Article]