What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy (n=345). Intervention: Presence of Late Gadolinium Enhancement (LGE) vs. Absence of LGE. Primary outcome: Cardiovascular events (HR 7.436, 95% CI 1.001-55.228, p=0.050).

January 1, 2014Open Access

Prognostic Value of Late Gadolinium Enhancement on Cardiac Magnetic Resonance Imaging in Japanese Hypertrophic Cardiomyopathy Patients

Key Result

The presence of late gadolinium enhancement on cardiac magnetic resonance imaging independently predicted cardiovascular events in Japanese patients with hypertrophic cardiomyopathy (HR 7.436).

Study Design

Type

Cohort (n=345)

Multicenter

Structured PICO

Does the presence of late gadolinium enhancement on CMR predict cardiovascular events in Japanese patients with hypertrophic cardiomyopathy?

Population

345 Japanese patients with hypertrophic cardiomyopathy (HCM), mean age 59±17 years, 62.0% male. Key exclusions: old myocardial infarction, concurrent congenital heart disease, severe valvular disease, prior percutaneous transluminal septal myocardial ablation (PTSMA) or septal myectomy, and renal dysfunction (eGFR <30 ml/min/1.73m2).

Intervention

Presence of late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (CMR) imaging

Comparator

Absence of late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (CMR) imaging

Outcome

Composite of cardiovascular events (cardiac death, sudden death, aborted sudden death, sustained ventricular tachycardia, appropriate ICD discharge, unscheduled hospitalization for heart failure, stroke, or acute myocardial infarction) at mean 21.8 months follow-upcomposite

The presence of late gadolinium enhancement on CMR is an independent predictor of adverse cardiovascular events in Japanese patients with hypertrophic cardiomyopathy.

Main Result

Effect estimate: HR 7.436 (95% CI 1.001-55.228)

Absolute Event Rate: 6.2% vs 0.6%

p-value: p=0.050

Limitations

Retrospective, single-center study conducted in a tertiary hospital
Subjects did not include patients already implanted with ICD
LGE evaluation was conducted visually and was semi-quantitative
Mean follow-up period was short
NSVT and low blood pressure during exercise test were not included in analyses

Abstract

BACKGROUND: The prognostic value of late gadolinium enhancement (LGE) on contrast-enhanced cardiovascular magnetic resonance (CMR) in Japanese hypertrophic cardiomyopathy (HCM) patients in a large, single-center cohort was investigated. METHODS AND RESULTS: A total of 345 HCM patients (mean age, 59±17 years; 214 male) underwent CMR with gadolinium enhancement, and were followed (mean duration, 21.8 months) for cardiovascular events. Patients were divided into event-positive and event-negative groups. The clinical and CMR characteristics were compared between the 2 groups, and predictors of cardiovascular events assessed on multivariate analysis. LGE was positive in 252 patients (73%). The annual cardiovascular events rate was significantly higher in patients with LGE than in those without (6.2%/year vs. 0.6%/year, P=0.003). On multivariate analysis, LGE (hazard ratio HR, 7.436; 95% confidence interval CI: 1.001-55.228, P=0.050), increased myocardial mass index (HR, 1.013; 95% CI: 1.002-1.023, P=0.018), reduced left ventricular ejection fraction (HR, 0.965; 95% CI: 0.945-0.985, P=0.001), and atrial fibrillation (HR, 2.257; 95% CI: 1.024-4.976, P=0.043) were significantly associated with cardiovascular events. CONCLUSIONS: The presence of LGE, increased myocardial mass index, reduced left ventricular ejection fraction and atrial fibrillation were independent predictors of adverse prognosis in Japanese HCM patients.

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