Objectives: To determine the prevalence of myocardial crypts in left ventricular (LV) hypertrophy secondary to aortic stenosis (AS), hypertrophic cardiomyopathy (HCM), and systemic hypertension (HTN) using cardiac computed tomography (CT).
Background: Myocardial crypts are discrete invaginations in LV myocardium. Recent magnetic resonance imaging studies suggest a higher prevalence of crypts in patients with HCM and also within small numbers of genotype positive but phenotype negative relatives. However, the prevalence of crypts in patients with LV hypertrophy of other etiologies is unclear.
Methods: Consecutive 80 patients with severe symptomatic AS, 42 patients with HCM, 40 patients with HTN, and 40 normal subjects underwent ECG-gated, contrast enhanced 256-slice CT. Crypts were defined as >50% invaginations into normal myocardium during diastole and their overall prevalence and location was investigated and compared between different patient groups with LV hypertrophy. LV mass was calculated in the mid-diastolic frame of the CT dataset.
Results: The prevalence of crypts was 41% (17/42) in patients with HCM, 33% (26/80) in severe AS, 15% (6/40) in HTN, and 5% (2/40) in the predefined normal control group. The highest prevalence of crypts was observed in patients with HCM (P < 0.001); however, their prevalence did not correlated with LV mass (r = 0.12, P = 0.21). They were most commonly located in the septum of the left ventricle (58.5%). Among the patients with LV hypertrophy crypts in the inferobasal segment were observed only in those with HCM.
Conclusions: Myocardial crypts are common in patients with LV hypertrophy, and especially in HCM. Inferobasal myocardial crypts may be characteristic of patients with HCM referred for cardiac CT.
