Prognostic Significance of Myocardial Fibrosis in Hypertrophic Cardiomyopathy
Key result
CMR-detected myocardial fibrosis in HCM linked to ~240% greater risk of major clinical events.
- HR 3.4
- P=0.006
- n=217
Why the study?
The role of myocardial fibrosis in predicting sudden death and heart failure in hypertrophic cardiomyopathy is unclear with a lack of prospective data.
Population
217 consecutive hypertrophic cardiomyopathy patients
Comparison
Patients with myocardial fibrosis vs patients without fibrosis
Design
Prospective cohort study
Follow-up
3.1 +/- 1.7 years
Authors
Discussion
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Implication
May refine HCM sudden-death risk models with LGE; leaves open whether fibrosis-guided interventions improve outcomes.
Key Points
- To evaluate whether myocardial fibrosis detected by late gadolinium enhancement cardiac magnetic resonance predicts adverse clinical outcomes and sudden cardiac death in hypertrophic cardiomyopathy.
- Longitudinal cohort evaluation of patients with hypertrophic cardiomyopathy undergoing contrast-enhanced cardiovascular magnetic resonance imaging.
- Assessment of the presence, pattern, and extent of myocardial fibrosis using late gadolinium enhancement protocols with systematic tracking of adverse cardiovascular endpoints.
- Myocardial fibrosis detected via late gadolinium enhancement is present in a substantial proportion of patients with hypertrophic cardiomyopathy.
- The presence and extent of fibrosis are significantly associated with elevated rates of major adverse clinical events, including sudden cardiac death, ventricular arrhythmias, and heart failure progression.
Study Design
Type
Cohort (n=217)
PICO
P
Population
217 consecutive patients with hypertrophic cardiomyopathy followed prospectively for a mean of 3.1 years.
E
Exposure / Comparator
Myocardial fibrosis detected by late gadolinium enhancement cardiovascular magnetic resonance vs No myocardial fibrosis
O
Primary Outcome
Combined primary end point of cardiovascular death, unplanned cardiovascular admission, sustained ventricular tachycardia or ventricular fibrillation, or appropriate implantable cardioverter-defibrillator discharge — HR 3.4, p=0.006
Main Result
Hazard Ratio: 3.4
Absolute Event Rate: 25% vs 7.4%
p-value: p=0.006
Cite This Study
O’Hanlon et al. (2010) conducted a cohort in hypertrophic cardiomyopathy (HCM) (n=217). Myocardial fibrosis detected by late gadolinium enhancement cardiovascular magnetic resonance vs. No myocardial fibrosis was evaluated on Combined primary end point of cardiovascular death, unplanned cardiovascular admission, sustained ventricular tachycardia or ventricular fibrillation, or appropriate implantable cardioverter-defibrillator discharge (HR 3.4, p=0.006). Myocardial fibrosis detected by cardiovascular magnetic resonance in hypertrophic cardiomyopathy increased the risk of major clinical events compared to no fibrosis (25% vs 7.4%; HR 3.4, p=0.006).