Patterns of Right Ventricle Affection in Adult Patients with Hypertrophic Cardiomyopathy: Cardiac Magnetic Resonance Study

Background: Hypertrophic cardiomyopathy (HCM) primarily affects the left ventricle (LV), but right ventricular (RV) involvement is increasingly recognized and may have prognostic implications. Advanced imaging modalities like cardiac magnetic resonance (CMR) offer valuable insights into RV changes in HCM but remain underutilized. Objective: This study aimed to evaluate RV structural and functional changes in HCM using CMR. Patients and Methods: A retrospective analysis of 64 adult HCM cases who underwent CMR between January 2020 and March 2024. Patients were categorized into HCM with RV hypertrophy (RVH) and without RVH. Key parameters such as RV and LV wall thickness, volumes, ejection fractions, and fibrosis by late gadolinium enhancement (LGE) were analyzed. Correlation and agreement between RV and LV parameters were assessed using Pearson correlation and Intraclass Correlation Coefficient (ICC). Results: RVH was present in 15.6% of cases and associated with significantly greater RV wall thickness and fibrosis (90% vs. 9.3%, p = 0.001). RVH cases exhibited higher LV end-diastolic volume (164.45 ± 52.01 vs. 138.75 ± 34.3, p = 0.05) and universal LV fibrosis (100% vs. 59.3%, p = 0.012). Significant correlations between RV and LV end-diastolic volumes (r = 0.559, p = 0.001) and stroke volumes (r = 0.620, p = 0.001) were noted. Agreement analysis showed good concordance for EF (ICC = 0.736) and stroke volume (ICC = 0.758). Conclusion: RVH in HCM is linked to marked structural and functional changes. CMR provided valuable insights into biventricular dynamics, and future research should integrate clinical and genetic data to refine management strategies.