CMR Case-based Masterclass for Early Career - Webinar 1: Approach to LV hypertrophy-Webinar 1: Approach to LV hypertrophy

Video Transcription

Video Summary

This webinar opened the 2024–2025 CMR Masterclass series with a focus on assessing left ventricular hypertrophy (LVH) using cardiac MRI. Moderators Purvi Parwani and Vinita Ojha welcomed a global audience and introduced three expert talks on how CMR helps distinguish true hypertrophic cardiomyopathy (HCM) from phenocopies and other causes of thickened myocardium.<br /><br />Dr. James Moon emphasized that LVH is a complex, heterogeneous response to cardiac injury and that MRI adds value beyond echocardiography by identifying morphology, fibrosis, perfusion abnormalities, and early disease features. He highlighted limitations of the traditional 15 mm wall-thickness cutoff and advocated for demographic adjustment, AI-assisted measurement, and multiparametric assessment. He also discussed the importance of late gadolinium enhancement (LGE), T1 mapping, extracellular volume (ECV), and emerging perfusion imaging in diseases such as amyloidosis, Fabry disease, and HCM.<br /><br />Dr. Ahmad Masri presented numerous real-world cases showing how CMR can prevent misdiagnosis, especially when hypertension, obesity, or borderline wall thickness obscure the true etiology. He stressed the need to “explain all LVH,” use genetic testing and biopsy selectively, and recognize phenocopies such as Fabry disease, amyloidosis, eosinophilic myocarditis, mitochondrial cardiomyopathy, and inflammatory cardiomyopathy.<br /><br />Dr. Brian Halliday focused on rarer phenocopies, including mitochondrial disease, Danon disease, Fabry disease in women, and congenital abnormalities. He described imaging clues such as low T1, atypical fibrosis patterns, rapidly progressive hypertrophy, pre-excitation, and unusual valve or papillary muscle abnormalities.<br /><br />The session concluded with audience Q&A on when to pursue CMR, genetic testing, biopsy, and rhythm monitoring, reinforcing the central message: LVH should not be dismissed, and CMR is essential for precise diagnosis and management.

Keywords

cardiac MRI

left ventricular hypertrophy

hypertrophic cardiomyopathy

phenocopies

late gadolinium enhancement

T1 mapping

extracellular volume

amyloidosis

Fabry disease

myocardial fibrosis