A Closer Look Into Segmental Wall Thickness: ECG Never Lies!

A 50-year-old man of Hispanic background with past medical history of hypertension and dyslipidemia presents to the emergency department with intermittent chest pain and an abnormal electrocardiogram (ECG) (Figure 1).

Figure 1: Sinus rhythm with left ventricular hypertrophy and deep symmetric T wave inversion in the lateral leads

Figure 1

He has no known family history of cardiovascular disease. Blood pressure is 143/83 mmHg and heart rate is 67 bpm. The patient's echocardiogram shows normal biventricular function without wall motion abnormalities. Serial troponin I levels are negative and coronary computed tomography angiography (CTA) demonstrates normal coronary arteries (Coronary Artery Disease Reporting and Data System [CAD-RADS] 0). Given ECB abnormalities, a cardiovascular magnetic resonance (CMR) is ordered for further characterization (Figures 2,3, and Video 1).

Figure 2: End-diastolic fast imaging employing steady-state acquisition (FIESTA) images showing the lack of wall thickness tapering from basal to apical segments

Figure 2

Figure 3: Late gadolinium enhancement images showing the absence of myocardial uptake (normal pattern)

Figure 3

Video 1: Long axis Cine FIESTA

Video 1

Considering the CMR findings, what is the most appropriate next step in this patient's care?

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