INTRODUCTION: Hypertrophic cardiomyopathy (HCM) is associated with myocardial 
scarring and ventricular tachycardia (VT). Contrast-enhanced cardiac magnetic 
resonance imaging (CE-CMR) can quantify myocardial scar, and scar imaging has 
been documented in patients with HCM. We investigated the assessment of 
myocardial scar in HCM patients using CE-CMR, and its correlation with proven 
VT.
METHODS: Twenty-five patients (mean age 54 +/- 8) with HCM who underwent CE-CMR 
were identified, and clinical data obtained from chart review. Parameters of LV 
function were calculated from cine imaging, and myocardial scar was assessed 
using delayed enhancement imaging following gadolinium administration.
RESULTS: Myocardial scar was detected in 16 (64%) patients with a mean mass 9 
+/- 15 g. Scar was patchy, mid-myocardial and located in the basal anteroseptum, 
and RV insertion sites. Scar was seen in septal, apical and concentric variants 
of HCM. Scar mass correlated with both LV Mass (r2 = 0.74) and maximal LV wall 
thickness (r2 = 0.42). VT occurred in 32% of patients, and was associated with 
both increased scar mass and wall thickness compared to non-VT patients (21 +/- 
22 g vs. 4 +/- 6 g, and 2.4 +/- 0.5 cm vs. 1.8 +/- 0.5 cm, p < 0.05). LV size 
and function were similar in patients with and without VT. A scar mass of >7 g 
predicted the presence of VT with a sensitivity of 75% and specificity 82%.
CONCLUSIONS: Myocardial scar imaged by CE-CMR is common in patients with HCM, 
and is predictive of VT. Scar is seen in all HCM variants, and is associated 
with maximal wall thickness. There may be a role for CE-CMR in improved risk 
stratification for individual patients with HCM.