Abstract 13139: Prognostic Utility of Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy: An International Multicenter Study
Background. Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden death in the young, although identification of at-risk patients remains incomplete. Contrast-enhanced cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) has emerged as an in vivo marker of myocardial fibrosis, although its significance in identifying HCM patients at risk for sudden death remains unresolved.
Methods. We used LGE CMR to assess the relationship between hyperenhancement (as % of LV mass) on morbidity and mortality in 1293 HCM patients (mean age 46±17, 63% male) followed for 3.4±1.7 years.
Results. Over the follow-up period, sudden death events occurred in 37 (2.9%) patients and adverse heart-failure-related events and death in 120 (9.3%) patients. Sudden death risk increased in relation to the quantity of LGE (p<0.001), with LGE ≥20% LV mass conferring a 2-fold increase in risk, even in the absence of conventional risk factors. The absence of LGE was associated with very low risk for sudden death (HR 0.34, p=0.003). Risk of progression to NYHA class III/IV, development of end-stage HCM, or death from heart failure also increased in relation to the quantity of LGE (p<0.001). Multivariable analysis showed that extent of LGE was independently associated with increased risk of sudden death (adj HR 1.38/10% LGE, 95% CI: 1.05-1.82) and adverse heart failure-related events and death (adj HR 1.34/10% LGE, 95% CI: 1.15-1.56).
Conclusions. In patients with HCM, extensive (≥20%) LGE is an independent predictor of sudden death and represents a novel CMR-based risk marker for identifying high-risk patients who may benefit from ICD therapy. Absence of LGE is associated with very low risk and a potential source of reassurance to patients.
- © 2012 by American Heart Association, Inc.