Key result
Late gadolinium enhancement >5% (Adj. HR 6.16) and a history of syncope (Adj. HR 3.40) were independently associated with ventricular tachycardia, ICD therapy, or mortality in HCM patients.
Why the study?
Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy remains challenging, and the clinically significant threshold of late gadolinium enhancement on cardiac MRI remains debated.
Does late gadolinium enhancement > 5% on cardiac MRI or a history of syncope predict adverse clinical outcomes in patients with hypertrophic cardiomyopathy?
Cohort (n=230)
No
Does late gadolinium enhancement > 5% on cardiac MRI or a history of syncope predict adverse clinical outcomes in patients with hypertrophic cardiomyopathy?
Hazard Ratio: 6.16
In patients with hypertrophic cardiomyopathy, even small amounts of late gadolinium enhancement (>5%) on cardiac MRI and a history of syncope are strong independent predictors of ventricular arrhythmias and mortality.
LGE >5% and syncope history may aid HCM risk stratification; hypothesis-generating and requires prospective validation before guiding decisions.
Background: Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy (HCM) remains challenging. Late gadolinium enhancement (LGE) on cardiac MRI signifies myocardial fibrosis and is linked to adverse outcomes in HCM. However, the threshold of LGE that is clinically significant remains a subject of debate. We hypothesized that even small amounts of LGE (≥ 5%) or a history of syncope are associated with worse outcomes. Methods: Between May 2018 and June 2023, HCM patients were prospectively enrolled at the Medical University of Vienna, Austria, a tertiary referral center. The primary endpoint was a composite of new-onset ventricular tachycardia, appropriate ICD therapy, and all-cause mortality. Results: In total, 230 patients were included. The median age of patients was 56 (IQR 44, 64) years, 40% (n = 94) were female, and 43% (n = 84) had significant left ventricular outflow tract obstruction (LVOTO). Over a median follow-up of 3.2 years, 29 patients (13%) met the composite endpoint. While the ESC HCM risk score was not associated with the primary endpoint, both LGE > 5% (Adj. HR 6.16) and a history of at least one syncope (Adj. HR 3.40) were independently associated with the primary endpoint. These associations were consistent across patients with and without LVOTO. Conclusions: In conclusion, our findings indicate that the combination of a history of syncope together with small amounts of LGE (≥ 5%) in cardiac MRI are associated with unfavorable clinical outcomes in HCM patients
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Mann et al. (2025) conducted a cohort in Hypertrophic cardiomyopathy (HCM) (n=230). Late gadolinium enhancement (LGE) > 5% and history of syncope vs. LGE ≤ 5% and no history of syncope was evaluated on Composite of new-onset ventricular tachycardia, appropriate ICD therapy, and all-cause mortality (Adj. HR 6.16). Late gadolinium enhancement >5% (Adj. HR 6.16) and a history of syncope (Adj. HR 3.40) were independently associated with ventricular tachycardia, ICD therapy, or mortality in HCM patients.
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