Table 1. Cardiac MRI Characteristics for Differentiation of Thickened Myocardium Based on Histologic Features.
| Hypertrophic Cardiomyopathy | Hypertensive Heart Disease | Aortic Stenosis | Anderson-Fabry Disease | Amyloidosis | Mitochondrial Cardiomyopathy | Sarcoidosis | Athlete's Heart | |
|---|---|---|---|---|---|---|---|---|
| LVH pattern | Asymmetric > Concentric | Concentric > Asymmetric | Concentric > Asymmetric | Concentric > Asymmetric | Concentric > Asymmetric | Concentric > Asymmetric | Concentric > Asymmetric (acute) | Concentric > Asymmetric |
| Unique histologic features | Cardiomyocyte hypertrophy, hypertrophic nuclei, disorganized myofibrillary arrangement, interstitial fibrosis | Cardiomyocyte hypertrophy with parallel alignment, interstitial and perivascular fibrosis | Cardiomyocyte hypertrophy and interstitial fibrosis | Mild cardiomyocyte hypertrophy, perinuclear and cytoplasmic vacuoles (lysosomal glycosphingolipid accumulation) | Extracelluar homogenous, eosinophilic substance deposited in interstitium | Peripheral and intermyofibrillar accumulation of abnormal mitochondria: ragged red fiber on modified Gomori trichrome stain | Noncaseating epithelioid granulomas and multinucleated giant cells in interstitium, distributed along the lymphatics | Cardiomyocyte hypertrophy without interstitial fibrosis |
| T1 value | ↑ | ↑ | ↑ | ↓↓ | ↑↑ | ↑ | ↑ | ↓/↔ |
| T2 value | ↑/↔ | ↔ | ↔ | ↑/↔ | ↑ | ↑↑ | ↑ (acute) | ↔ |
| ECV fraction | ↑ | ↑ | ↑ | ↑/↔ | ↑↑ | ↔ | ↑ | ↓ |
| LGE | ++/+/− Multifocal patchy |
+/− | +/− | +/− Inferolateral |
++/+ Circular subendocardial |
+/− | ++/ Multifocal patchy, epicardial |
Rare |
| LV strain on CMR | ↓↓ | ↓/↔ | ↓ In severe AS |
↓ Loss of base-to-apex circumferential strain gradient |
↓↓ Relative apical sparing |
↓ | ↔ | |
| Additional features | LVOT jet flow, and small LV cavity | Hypertension | AV jet flow | Systemic involvement | Atrial involvement, pericardial or pleural effusion | Hearing loss, low skeletal mass, and pericardial effusion | FDG PET (+) | Proportional cavity enlargement, improved LVH after detraining |
AS = aortic valve stenosis, AV = aortic valve, CMR = cardiac magnetic resonance, ECV = extracellular volume, FDG = fluorodeoxyglucose, LGE = late gadolinium enhancement, LV = left ventricular, LVH = left ventricular hypertrophy, LVOT = left ventricular outflow tract, ↑ = mild increase, ↑↑ = moderate to marked increase, ↓ = mild decrease, ↓↓ = moderate to marked decrease, ↔ = within normal range