Hypertrophic cardiomyopathy, fibrosis, and aortic stiffness: an unidentified association unraveled by magnetic resonance imaging.

t i w ortic stiffness has been identified as an important predictor f cardiovascular outcome independent of and additive to raditional cardiovascular risk factors in different patient opulations including patients with hypertension (1), diaetes (2), and end-stage renal disease (3), and in elderly ospitalized subjects (4). More recently, the prognostic ignificance of increased aortic stiffness has also been demnstrated in the general population (5). The adverse effects f elevated aortic stiffness are thought to be caused by a remature return of reflected pressure waves in late systole, hich increases central pressure and thus systolic blood ressure. Increased systolic blood pressure, in turn, increases he load on the left ventricle, inducing left ventricular ypertrophy, increasing myocardial oxygen demand, and ausing subendocardial ischemia. In addition to the effects n the heart, increased aortic stiffness has been associated ith an increase in the risk of stroke. Elevated aortic tiffness is not confined to aging or atherosclerotic diseases ut has also been reported in noncardiovascular disorders uch as generalized inflammatory diseases like rheumatoid rthritis (6) or genetic disorders such as the Marfan synrome (7). Interestingly, there have been no reports so far nvestigating aortic stiffness in patients with hypertrophic ardiomyopathy (HCM).