Correspondence Article Type Response to Letter Regarding Article, “Clinical Impact of Contemporary Cardiovascular Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy” We appreciate the comments by Ferreira et al regarding our recent Clinician Update on the clinical impact of cardiovascular magnetic resonance (CMR) in hypertrophic cardiomyopathy (HCM).1 We agree completely with the authors that the diagnosis and clinical management of patients with this complex genetic heart disease has been substantially enhanced by applying CMR to large consecutive cohorts of this disease over the past 10 years. Indeed, CMR is ideally suited to defining the diverse HCM phenotype2 by providing images with high spatial resolution, sharp contrast between the myocardial border and blood pool (permitting more reliable left ventricular wall thickness measurements than is possible with echocardiography in some patients),2 and visualization of all left ventricular segments without obliquity. In addition, contrast-enhanced CMR with late gadolinium enhancement has the capability of identifying areas of myocardium occupied by fibrosis/scarring, information not obtainable with echocardiography. In this regard, CMR has become part of the HCM risk stratification algorithm, identifying candidates for implantable defibrillators and prevention of sudden death, even in the absence of conventional risk markers.3 These imaging strengths of CMR have resulted in improved diagnosis and risk prediction, thereby introducing into cardiovascular practice a new era of imaging for HCM. We therefore agree with an expanded role for CMR in HCM, to be performed at least once as part of the contemporary assessment of all patients with a confirmed (or suspected) HCM diagnosis. For these reasons, recent expert consensus documents from American Heart Association/European Society of Cardiology/ European Association of Cardiovascular Imaging have also emphasized the role of CMR in HCM.4–5 In addition, despite historical differences in the approach to certain aspects of HCM management among investigators in the United States and Europe, we are pleased to see that the importance of CMR in HCM has emerged as an area of common ground independent of the national origin of the clinical imagers. We are hopeful that this mutual enthusiasm and support will help facilitate future investigations aimed at improving our understanding of how CMR can further impact clinical management strategies for patients with HCM.

Disclosures None.

Martin S. Maron, MD Hypertrophic Cardiomyopathy Center Division of Cardiology Tufts Medical Center Boston, MA Barry J. Maron, MD Hypertrophic Cardiomyopathy Center Minneapolis Heart Institute Minneapolis, MN

References 1. Maron MS, Maron BJ. Clinical impact of contemporary cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy. Circulation. 2015;132:292–298. doi: 10.1161/CIRCULATIONAHA.114.014283. 2. Maron MS, Maron BJ, Harrigan C, Buros J, Gibson CM, Olivotto I, Biller L, Lesser JR, Udelson JE, Manning WJ, Appelbaum E. Hypertrophic cardiomyopathy phenotype revisited after 50 years with cardiovascular magnetic resonance. J Am Coll Cardiol. 2009;54:220–228. doi: 10.1016/j.jacc.2009.05.006. 3. Chan RH, Maron BJ, Olivotto I, Pencina MJ, Assenza GE, Haas T, Lesser JR, Gruner C, Crean AM, Rakowski H, Udelson JE, Rowin E, Lombardi M, Cecchi F, Tomberli B, Spirito P, Formisano F, Biagini E, Rapezzi C, De Cecco CN, Autore C, Cook EF, Hong SN, Gibson CM, Manning WJ, Appelbaum E, Maron MS. Prognostic value of quantitative contrastenhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation. 2014;130:484–495. doi: 10.1161/CIRCULATIONAHA.113.007094. 4. Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rawkowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American Society of Echocardiography; American Society of Nuclear Cardiology; Heart Failure Society of America; Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124:e783–e831. 5. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2733–2779.

(Circulation. 2016;133:e422. DOI: 10.1161/CIRCULATIONAHA.115.020199.) © 2016 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org

DOI: 10.1161/CIRCULATIONAHA.115.020199

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Response to Letter Regarding Article, ''Clinical Impact of Contemporary Cardiovascular Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy'' Martin S. Maron and Barry J. Maron Circulation. 2016;133:e422 doi: 10.1161/CIRCULATIONAHA.115.020199 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2016 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

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