Prevalence of Myocardial Crypts in the Hypertrophied Heart: a Computed Tomography Study - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Ziad Aro Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel Mithal Nassar Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel Daniel Monakier Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel Tamir Bental Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel Gideon Shafir Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel Abid Assali Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel Hana Vaknin-Assa Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel Ran Kornowski Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel Ashraf Hamdan Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel

Background: Myocardial crypts are discrete invaginations in left ventricular (LV) myocardium. Recent magnetic resonance imaging studies suggest a high prevalence of crypts in patients with hypertrophic cardiomyopathy (HCM); however, the prevalence of crypts in patients with LV hypertrophy of different etiologies remains unclear.

Objectives: The aim of the present study was therefore to determine the prevalence and characteristics of myocardial crypts in pathologic LV hypertrophy and to evaluate their possible association with HCM.

Methods: We investigated, 100 patients with systemic hypertension (SH), 120 patients with aortic stenosis (AS), 73 patients with HCM and 100 normal subjects, who underwent ECG-gated; contrast enhanced computed tomography (CT). Crypts were defined as >50% invaginations into normal myocardium during diastole and their overall prevalence, location, and characteristics were investigated and compared between patients with SH, AS, HCM, and normal subjects.

Results: The overall prevalence of crypts in LV hypertrophy was significantly higher compared to normal subjects (33/293, 11.3% vs. 4/100, 4%; P < 0.001). Among patients with LV hypertrophy the highest incidence was observed in patients with HCM (P < 0.001): crypts were identified in 18 patients with HCM (24.7% of 73), in 7 patients with SH (7% of 100), and in 8 patients with AS (6.7% of 120). The probability of HCM was significantly higher among patients with crypts (P < 0.001), which was not affected by LV mass. Crypts in HCM showed deeper penetrance into myocardium compared to patients with SH, AS, and normal subjects and the detection of three or more crypts was only identified in patients with HCM.

Conclusions: Myocardial crypts were identified by contrast CT in patients with LV hypertrophy of different etiology, but most frequently associated with the diagnosis of HCM independently of LV mass.