What is the clinical evidence from this study?

Study design: Observational. Population: Hypertrophic cardiomyopathy (HCM) (n=187). Intervention: Cardiac magnetic resonance (CMR) markers (Left ventricular mass index). Primary outcome: Combined endpoint of all-cause mortality, heart transplantation, malignant ventricular arrhythmias and appropriate ICD therapy (HR 1.01, 95% CI 1.00-1.02, p=0.011).

February 8, 2021Open Access

Prognostic significance of cardiac magnetic resonance-based markers in patients with hypertrophic cardiomyopathy

Resultado clave

Left ventricular mass index was an independent cardiac magnetic resonance predictor of major clinical events (HR 1.01) in patients with hypertrophic cardiomyopathy.

Diseño del estudio

Tipo

Observational (n=187)

Multicéntrico

PICO estructurado

Do cardiac magnetic resonance-based markers (LVMi, myocardial fibrosis, and strain parameters) predict mortality and arrhythmia events in patients with hypertrophic cardiomyopathy?

Población

187 patients with an unequivocal diagnosis of hypertrophic cardiomyopathy (HCM) and lack of confounding comorbidities (untreated hypertension, significant aortic stenosis, previous myocardial infarction, prior surgical myectomy, or percutaneous transluminal septal myocardial ablation), evaluated at a tertiary referral center in Hungary.

Intervención

Cardiac magnetic resonance (CMR) imaging including assessment of left ventricular mass index (LVMi) using conventional and threshold-based methods, late gadolinium enhancement (LGE) for myocardial fibrosis quantification, and feature-tracking (FT) strain analysis.

Resultado

Combined endpoint of all-cause mortality, heart transplantation, malignant ventricular arrhythmias, and appropriate implantable cardioverter defibrillator (ICD) therapy at 3.8 ± 2.4 years follow-up.composite

CMR-derived left ventricular mass index and myocardial fibrosis provide significant independent prognostic value for major clinical and arrhythmic events in patients with hypertrophic cardiomyopathy.

Resultado numérico

Estimación del efecto: HR 1.01 (95% CI 1.00-1.02)

valor p: p=0.011

Limitaciones

Single-centre study, which might limit generalizability
Retrospective nature with limited clinical data available for some patients
Myocardial T1 and T2 mapping and myocardial extracellular volume evaluation were not available
No genetic testing was performed in the vast majority of the patients

Resumen

The prognosis of patients with hypertrophic cardiomyopathy (HCM) varies greatly. Cardiac magnetic resonance (CMR) is the gold standard method for assessing left ventricular (LV) mass and volumes. Myocardial fibrosis can be noninvasively detected using CMR. Moreover, feature-tracking (FT) strain analysis provides information about LV deformation. We aimed to investigate the prognostic significance of standard CMR parameters, myocardial fibrosis, and LV strain parameters in HCM patients. We investigated 187 HCM patients who underwent CMR with late gadolinium enhancement and were followed up. LV mass (LVM) was evaluated with the exclusion and inclusion of the trabeculae and papillary muscles (TPM). Global LV strain parameters and mechanical dispersion (MD) were calculated. Myocardial fibrosis was quantified. The combined endpoint of our study was all-cause mortality, heart transplantation, malignant ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapy. The arrhythmia endpoint was malignant ventricular arrhythmias and appropriate ICD therapy. The LVM index (LVMi) was an independent CMR predictor of the combined endpoint independent of the quantification method (p < 0.01). The univariate predictors of the combined endpoint were LVMi, global longitudinal (GLS) and radial strain and longitudinal MD (MDL). The univariate predictors of arrhythmia events included LVMi and myocardial fibrosis. More pronounced LV hypertrophy was associated with impaired GLS and increased MDL. More extensive myocardial fibrosis correlated with impaired GLS (p < 0.001). LVMi was an independent CMR predictor of major events, and myocardial fibrosis predicted arrhythmia events in HCM patients. FT strain analysis provided additional information for risk stratification in HCM patients.

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