Myocardial fibrosis can occur in patients who have hypertrophic cardiomyopathy 
in the absence of epicardial coronary disease. In such patients, myocardial 
fibrosis has been linked to a poorer prognosis than in those without fibrosis. 
Gadolinium-DTPA delayed-enhancement magnetic resonance imaging (de-MRI) 
accurately identifies regions of myocardial fibrosis. We used de-MRI to screen 
for myocardial fibrosis in 8 patients with nonobstructive hypertrophic 
cardiomyopathy that had been diagnosed by 2-dimensional echocardiography. After 
localization of the heart and acquisition of electrocardiographically gated cine 
images, gadolinium-DTPA (0.2 mmol/kg) was administered to the patient. Fifteen 
minutes later, de-MRI images were obtained using a T1-weighted, 
inversion-recovery fast, low-angle shot sequence. Images were gated to 
end-diastole and obtained during a single breath-hold. The inversion time was 
modified iteratively to obtain maximal nulling of the signal from the 
ventricular myocardium. Regions of myocardium with abnormally high signals 
(>300% of remote normal myocardium) were designated as fibrotic. Eight patients 
with hypertrophic cardiomyopathy underwent de-MRI. The mean age was 52 years, 
the mean left ventricular mass was 201 grams, and the mean ejection fraction was 
0.68. In the 6 patients with recent clinical deterioration, de-MRI showed 
clearly delineated areas of myocardial fibrosis; no such areas were seen in the 
2 asymptomatic patients. We conclude that patients with symptomatic hypertrophic 
cardiomyopathy display regions of abnormal signal intensity on de-MRI that 
likely represent fibrosis. This technique may provide useful information in the 
evaluation of such patients and warrants further study.