Abstract
Background: Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) has emerged as a potential marker for risk of adverse events in patients with hypertrophic cardiomyopathy (HCM). However, previous studies have been limited to small cohorts with short follow-up periods and therefore the clinical significance of LGE in HCM remains uncertain.
Methods: Cine and contrast-enhanced CMR were performed on 594 HCM patients (49±16 years; 65% males). CMR scans were analyzed at a single data coordinating center. Mean follow-up was 3.5 ± 1.4 years.
Results: LGE was identified in 235 (40%) patients, occupying 10 ± 11% of LV myocardial volume. There was no statistically significant relationship between presence of LGE and a number of clinical end-points including all HCM-related adverse disease events (OR 1.64, 95% CI 0.99-2.70, p>0.05), progression to NYHA class III or IV or death from heart failure or stroke (OR 1.42, 95%CI 0.78-2.51, p=0.24), or sudden death (OR 1.89, 95% CI 0.78-4.55, p=0.16). However, when LGE was present a significant linear relation was evident between the extent of LGE and risk of progressive heart failure symptoms/cardiovascular death (OR 1.17/5% LGE, 95% CI 1.04-1.32; p<0.01) and sudden death (OR 1.20/5% LGE, 95%CI 1.04-1.40 p=0.016). HCM patients with extensive LGE ≥15% were at more than 3-fold higher risk of sudden death compared to patients with <15% or no LGE (OR 3.52, 95%CI 1.23-10.08, p=0.019). Multivariable analysis confirmed that extent of LGE was independently associated with an increased risk of sudden death (adj. OR 1.25/5% increase, p=0.02), even after controlling for traditional sudden death risk factors. The absence of LGE trended towards a low likelihood of experiencing HCM-related adverse events (adj. OR 0.59, 95% CI 0.34-0.99, p=0.052).
Conclusion: In patients with HCM, the amount of LGE (but not presence) was associated with an increased risk of HCM-related adverse events, including sudden death. Extensive LGE may represent a risk marker with the potential to arbitrate ambiguous decisions regarding ICD therapy. The absence of LGE is consistent with lower risk status and can be used to reassure patients.
Methods: Cine and contrast-enhanced CMR were performed on 594 HCM patients (49±16 years; 65% males). CMR scans were analyzed at a single data coordinating center. Mean follow-up was 3.5 ± 1.4 years.
Results: LGE was identified in 235 (40%) patients, occupying 10 ± 11% of LV myocardial volume. There was no statistically significant relationship between presence of LGE and a number of clinical end-points including all HCM-related adverse disease events (OR 1.64, 95% CI 0.99-2.70, p>0.05), progression to NYHA class III or IV or death from heart failure or stroke (OR 1.42, 95%CI 0.78-2.51, p=0.24), or sudden death (OR 1.89, 95% CI 0.78-4.55, p=0.16). However, when LGE was present a significant linear relation was evident between the extent of LGE and risk of progressive heart failure symptoms/cardiovascular death (OR 1.17/5% LGE, 95% CI 1.04-1.32; p<0.01) and sudden death (OR 1.20/5% LGE, 95%CI 1.04-1.40 p=0.016). HCM patients with extensive LGE ≥15% were at more than 3-fold higher risk of sudden death compared to patients with <15% or no LGE (OR 3.52, 95%CI 1.23-10.08, p=0.019). Multivariable analysis confirmed that extent of LGE was independently associated with an increased risk of sudden death (adj. OR 1.25/5% increase, p=0.02), even after controlling for traditional sudden death risk factors. The absence of LGE trended towards a low likelihood of experiencing HCM-related adverse events (adj. OR 0.59, 95% CI 0.34-0.99, p=0.052).
Conclusion: In patients with HCM, the amount of LGE (but not presence) was associated with an increased risk of HCM-related adverse events, including sudden death. Extensive LGE may represent a risk marker with the potential to arbitrate ambiguous decisions regarding ICD therapy. The absence of LGE is consistent with lower risk status and can be used to reassure patients.
| Original language | English |
|---|---|
| Pages (from-to) | E1570 |
| Number of pages | 1 |
| Journal | Journal of the American College of Cardiology |
| Volume | 59 |
| Issue number | 13 Supplement |
| Early online date | 25 Mar 2012 |
| DOIs | |
| Publication status | Published - 27 Mar 2012 |