CMR-derived LA-GLS predicted MACE in low-risk HCM patients with HR 2.17; combined with LVEF >50% and LGE <5%, identified subgroup with only 2% MACE rate.
Does CMR-derived LA-GLS predict major adverse cardiovascular events in patients with hypertrophic cardiomyopathy at low risk of sudden cardiac death?
CMR-derived LA-GLS improves risk stratification for major adverse cardiovascular events in HCM patients conventionally considered at low risk for sudden cardiac death.
Abstract Aims Hypertrophic cardiomyopathy (HCM) is associated with diverse cardiovascular outcomes. While the HCM Risk-SCD score effectively stratifies sudden cardiac death (SCD) risk, it provides limited insight into global cardiovascular prognosis, particularly among low-risk patients (HCM Risk-SCD score 4%). Left atrial global longitudinal strain (LA-GLS), derived from cardiovascular magnetic resonance (CMR), may enhance risk stratification. This study aimed to assess the prognostic value of CMR-derived LA-GLS in predicting major adverse cardiovascular events (MACE) in a cohort of low-risk HCM patients. Methods and Results In this retrospective longitudinal single-centre study, 183 low-risk HCM patients underwent CMR with LA-GLS assessment via feature tracking. The primary endpoint was a composite of MACE, including ventricular arrhythmias, heart failure, thromboembolic events, or all-cause death. The mean age was 64 ± 19 years; 47% were female. Over a median follow-up of 6.1 (2.8-8.5) years, 67 patients (37%) experienced MACE. The variables associated with MACE after adjustment were LA-GLS (HR 2.17, 95% CI 1.31-3.58, p = 0.002), maximal left ventricular (LV) wall thickness (HR 1.10, 95% CI 1.02-1.18, p = 0.015), late gadolinium enhancement (LGE) 5% of total myocardial mass (HR 2.00, 95% CI 1.01-3.97 p = 0.049), and LV ejection fraction (LVEF) 50% (HR 12.86, 95% CI 5.91-33.66, p 0.001). Patients with LVEF 50%, LGE 5%, and an LA-GLS 37.6% had a MACE rate of only 2%, identifying an overall low-risk subgroup. The prognostic value of LA-GLS was validated in an external cohort of 202 low-risk HCM patients. Conclusion CMR-derived LA-GLS improves risk stratification in HCM patients at low-risk of SCD and may refine management strategies and optimise resource allocation.
Faggiano et al. (2026) studied this question. CMR-derived LA-GLS predicted MACE in low-risk HCM patients with HR 2.17; combined with LVEF >50% and LGE <5%, identified subgroup with only 2% MACE rate.