Integrated Use of Late Gadolinium Enhancement and Left Ventricular Global Longitudinal Strain in Hypertrophic Cardiomyopathy

Figures

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  Figure 1. Distribution of LGE% and LV-GLS Measurements Across the Study Population (A) Histogram of late gadolinium enhancement (LGE%). (B) Histogram of left ventricular global longitudinal strain (LV-GLS). (C) Correlation plot between LGE% and LG-VLS.

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  Figure 2. Relationship of LGE% and LV-GLS With 5-Year CV Event Probability (A) Relationship of LGE% with 5-year cardiovascular (CV) event probability. (B) Relationship of LV-GLS with 5-year CV event probability. ∗HRs for 5-year CV event are presented. Abbreviations as in Figure 1.

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  Figure 3. Cumulative CV Events According to LGE% and LV-GLS Survival free from CV events according to median LGE% (>4.2% vs ≤4.2%) (A), median LV-GLS (<14.3% vs ≥14.3%).(B), and median LGE% and LV-GLS (C). The shaded area represents the 95% CI. Ref. = reference; other abbreviations as in Figures 1 and 2.

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  Figure 4. Mediation Analysis of LGE%, LV-GLS, and 5-Year CV Event A structural equation model shows the direct effect of LGE% on 5-year CV events and the indirect effect mediated by LV-GLS. (A) Model using LGE% and LV-GLS as continuous variables. (B) Model using LGE% and LV-GLS as categorical variables. Standardized beta-coefficients (β), along with 95% CIs and P values, are presented. Abbreviations as in Figures 1 and 2.

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  Figure 5. Cumulative SCD-Related Events According to LGE% and LV-GLS Survival free from sudden cardiac death (SCD)-related events according to median LGE% (>4.2% vs ≤4.2%) (A), median LV-GLS (<14.3% vs ≥14.3%) (B), and median LGE% and LV-GLS (C). The shaded area represents the 95% CI. Other abbreviations as in Figures 1 and 2.

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  Central Illustration. Summary of Main Study Findings (Upper panel) Myocardial fibrosis can be quantified by using cardiovascular magnetic resonance as a structural marker of left ventricular (LV) remodeling, while LV systolic dysfunction can be assessed with left ventricular global longitudinal strain (LV-GLS). Together, these assessments provide a comprehensive phenotyping of LV remodeling in hypertrophic cardiomyopathy (HCM). (Lower left panel) When patients were stratified into 4 groups based on the median values of late gadolinium enhancement (LGE%) and LV-GLS, the highest incidence of cardiovascular (CV) events was observed in those with both high LGE and low LV-GLS, whereas the other 3 groups had similar incidence rates. Low LGE indicates LGE ≤4.2%, and high LGE indicates >4.2%. Low LV-GLS indicates <14.3%, and high LV-GLS indicates ≥14.3%. (Lower right panel) In the mediation analysis, there was a significant direct effect of LGE% on CV events, as well as a significant indirect effect of LGE% mediated through LV-GLS.