Septal left ventricular hypertrophy: the role of cardiac magnetic resonance and feature tracking to distinguish hypertrophic cardiomyopathy from hypertensive heart disease

Abstract Background Septal left ventricular hypertrophy (LVH) can represent a diagnostic challenge, with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) being the most common differential diagnoses. Purpose To assess the ability of a multi-parametric cardiac magnetic resonance (CMR) evaluation, combined with electrocardiographic findings, to inform the differential diagnosis between HCM and HHD in patients presenting with septal LVH phenotype. Methods This two-center study enrolled consecutive patients with HCM (diagnosed as currently defined by guidelines) and HHD with septal LVH who underwent a clinically indicated CMR examination and ECG within 6 months. Patients with increased LV wall thickness in areas other than the basal and/or mid interventricular septum were excluded. A multi-parametric CMR protocol with cine, native T1 mapping, late gadolinium enhancement (LGE) imaging and feature-tracking strain analysis was performed. Results A total of 150 patients (86 HCM, 64 HHD) were included. HCM patients showed significantly greater septal maximal wall thickness (MWT) compared to HHD [median (IQR); HCM: 16 (15, 19); HHD: 14 (13, 15); p