We should distinguish pathologically between biventricular infiltration and hypertrophy
Biventricular hypertrophy is really rare event
Biventricular thickening /infiltration is also uncommon but should be what we think about when both ventricles are thick
So first question to address
Normal thickness of LV in diastole (number to remember is 1.2 but upper limits 1.4cms)
Normal thickness of RV in diastole (hard to measure but 3-5mms)
next question
What are the infiltrative cardiomyopathies that can cause biventricular infiltration
Most important to remember are
amyloidosis
sarcoidosis
Less commonly
Hemochromatosis
Fabry disease,
Danon disease, and
Friedreich?s ataxia.
How do they affect function
primarily affect diastolic function and
less commonly systolic function
Examples of Biventricular Thickening/Infiltration?
Our case with SLE, Sjogrens Raynauds
Location 3
Biventricular Infiltration
Two other more common causes of biventricular infiltration and thickening
Left Ventricular Septal and Free Wall Thickening Atrial Septal Thickening
Location 3
CARDIAC AMYLOIDOSIS with LV THICKENING – INFILTRATION VS LVH
Non gated axial CT through the opening of the mitral valve suggests early diastole confirms concentric thickening. The septum measures 24.1mms while the free wall measures 19.7mms. Upper limits normal is 14mms.
Non gated sagittal CT through the RVOT shows RVH (right ventricular thickening) wall measuring between 6-7mm involving both the RV inflow as well as the outflow See Case 006
Delayed gadolinium in Short Axis Shows Diffuse Dominantly Subendocardial and Myocardial LGE in both LV and RV
Location 3
CARDIAC AMYLOIDOSIS LGE SEQUENCE Gated short axis delayed gadolinium sequence through the base LV during diastole and shows subendocardial LGE (red arrowheads in a,b,c, and d, diffuse mid myocardial LGE (white arrowheads) (a,b,c,d) and subepicardial LGE in the RV (yellow arrowheads (b,c) Ashley Davidoff MD See Case 006
“A” INSIDE the HEART is for CONGO RED AMYLOIDOSIS The hallmark of cardiac amyloidosis is LGE involving subendocardial regions with apical sparing and sometimes the atria Ashley Davidoff MD
Re Other Chamber Involvement with Wall Thickening and Enlargement
Location 3
CARDIAC MUSCLE INFILTRATION OF CONGO RED AMYLOIDOSIS In cardiac amyloidosis increased LV thickness is common , but may involve RV and atrial septum with bilateral atrial enlargement. Ashley Davidoff MD
“S” STARTING SUPERFICIALLY NEAR THE SURFACE OF THE HEART The hallmark of cardiac sarcoidosis is LGE involving subepicardial regions of lateral free wall as well as medial basal septum but also mid myocardial with linear patchy and nodular forms. Biventricular involvement is common
Location 3
BIVENTRICULAR INFILTRATION Sarcoidosis involves both ventricles and may cause bi-ventricular thickening Ashley Davidoff MD
Next John Lee, Diastolic Heart Failure aka HF with Preserved EF
