What does this research mean for the field?

Right ventricular hypertrophy detected by cardiac magnetic resonance imaging independently predicts heart failure hospitalization and composite adverse events in patients with hypertrophic cardiomyopathy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the prognostic importance of right ventricular hypertrophy detected by cardiac magnetic resonance imaging in patients with hypertrophic cardiomyopathy and determine its incremental predictive value in 5-year sudden cardiac death risk models.

January 1, 2025Korean Journal of RadiologyOpen Access

Prognostic Implication of Right Ventricular Hypertrophy in Patients With Hypertrophic Cardiomyopathy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy (n=320). Intervention: Right ventricular hypertrophy (RVH) vs. Absence of right ventricular hypertrophy. Primary outcome: Heart failure hospitalization (HR 3.19, 95% CI 1.23-8.28, p=0.017).

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Key result

CMR-detected right ventricular hypertrophy predicts ~219% greater heart failure hospitalization risk in HCM.

HR 3.19
95% CI 1.23-8.28
P=0.017
n=320

Why the study?

To evaluate the prognostic significance of right ventricular hypertrophy (RVH) on CMR in hypertrophic cardiomyopathy and its incremental value in the 5-year SCD risk model.

Does right ventricular hypertrophy predict heart failure hospitalization and adverse events in patients with hypertrophic cardiomyopathy?

Key Points

To evaluate the prognostic importance of right ventricular hypertrophy detected by cardiac magnetic resonance imaging in patients with hypertrophic cardiomyopathy and determine its incremental predictive value in 5-year sudden cardiac death risk models.
Retrospective analysis of 320 patients with hypertrophic cardiomyopathy who underwent cardiac magnetic resonance imaging and echocardiography between 2007 and 2019, followed for a median duration of 7.7 years.
Right ventricular hypertrophy was defined as right ventricular wall thickness ≥ 5 mm; endpoints included heart failure hospitalization (primary) and a composite of heart failure hospitalization, cardiovascular death, and transplantation (secondary).
Right ventricular hypertrophy was present in 65 of 320 patients (20.1%) and independently predicted heart failure hospitalization (HR = 3.19, 95% CI = 1.23–8.28, P = 0.017) and composite adverse events (HR = 2.38, 95% CI = 1.01–5.64, P = 0.048).
Adding right ventricular hypertrophy to the 5-year sudden cardiac death risk model significantly improved Harrell's C-index from 0.606 to 0.688 (P = 0.033) for heart failure hospitalization and from 0.641 to 0.727 (P = 0.030) for composite events.

Study Design

Type

Cohort (n=320)

Multicenter

Structured PICO

Does right ventricular hypertrophy predict heart failure hospitalization and adverse events in patients with hypertrophic cardiomyopathy?

Population

320 patients with hypertrophic cardiomyopathy (HCM) who underwent CMR and echocardiography, mean age 57.5, 66.3% men.

Intervention

Presence of right ventricular hypertrophy (RVH) detected by CMR (defined as right ventricular wall thickness of 5 mm)

Comparator

Absence of right ventricular hypertrophy

Outcome

Heart failure (HF) hospitalizationhard clinical

Main Result

Effect estimate: HR 3.19 (95% CI 1.23-8.28)

p-value: p=0.017

CMR-detected right ventricular hypertrophy independently predicts heart failure hospitalization and adverse events in patients with hypertrophic cardiomyopathy, and improves the predictive performance of conventional risk models.

Limitations

Exclusion of individuals whose CMR was performed >6 months after echocardiography may have introduced selection bias
Single-center retrospective design limits control over confounding factors and generalizability
Relatively mild HCM phenotype contributed to a low overall event rate, reducing statistical power
Inherent challenges in accurately measuring the thin and heavily trabeculated right ventricular wall
Lack of standardized consensus diagnostic criteria for right ventricular hypertrophy

Implication

RVH on CMR may aid HCM risk stratification but should not yet change practice; hypothesis-generating pending prospective validation.

Abstract

Objective: To evaluate the prognostic significance of right ventricular hypertrophy (RVH) in patients with hypertrophic cardiomyopathy (HCM) using cardiac magnetic resonance imaging (CMR) and to assess its incremental value when incorporated into the established 5-year sudden cardiac death (SCD) risk prediction model.Materials and Methods: This retrospective study included 320 patients with HCM who underwent CMR and echocardiography between 2007 and 2019.RVH was defined as a right ventricular wall thickness of 5 mm.The primary event was heart failure (HF) hospitalization.The secondary events were a composite of HF hospitalization, cardiovascular death, and heart transplantation.The prognostic role of RVH was assessed using Kaplan-Meier survival analysis, Cox proportional hazards regression, and model performance metrics, including time-dependent receiver operating characteristic curve analysis for a 5-year follow-up and Harrell's C-index.Results: Among 320 patients (mean age 57.5 12.8 years; 66.3% men), 65 (20.1%) had RVH.Over a median follow-up of 7.7 years, 28 (8.8%) patients experienced HF hospitalization, and 34 (10.6%)experienced composite adverse events.In multivariable Cox models, RVH was an independent predictor of both events: HF hospitalization (hazard ratio [HR] = 3.19, 95% confidence interval [CI] = 1.23-8.28,P = 0.017) and the composite events (HR = 2.38, 95% CI = 1.01-5.64,P = 0.048).Incorporating RVH into the 5-year SCD risk model increased the time-dependent area under the curve, though not significant, from 0.620 to 0.725 for HF hospitalization (P = 0.057) and from 0.712 to 0.848 for composite events (P = 0.062).Harrell's C-index improved significantly from 0.606 to 0.688 (P = 0.033) and from 0.641 to 0.727 (P = 0.030), respectively.Conclusion: CMR-detected RVH independently predicts adverse events in patients with HCM.Incorporating RVH into a conventional risk model may enhance its predictive performance, supporting the importance of routine biventricular assessments in HCM evaluation.

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Cite This Study

Hong et al. (2025) conducted a cohort in Hypertrophic cardiomyopathy (n=320). Right ventricular hypertrophy (RVH) vs. Absence of right ventricular hypertrophy was evaluated on Heart failure hospitalization (HR 3.19, 95% CI 1.23-8.28, p=0.017). Right ventricular hypertrophy detected by cardiac magnetic resonance imaging independently predicted heart failure hospitalization (HR 3.19) in patients with hypertrophic cardiomyopathy.

synapsesocial.com/papers/6a10bc22ba20d9a181ee3a3c https://doi.org/10.3348/kjr.2025.0301