Key result
LGE over 5% in HCM is linked to a ~13% 10-year sudden cardiac death risk.
Why the study?
Established sudden cardiac death risk models in hypertrophic cardiomyopathy have suboptimal discriminative power, necessitating evaluation of alternative risk stratification strategies.
Does late gadolinium enhancement (LGE) amount on CMR improve sudden cardiac death risk stratification in patients with hypertrophic cardiomyopathy?
Cohort (n=203)
Does late gadolinium enhancement (LGE) amount on CMR improve sudden cardiac death risk stratification in patients with hypertrophic cardiomyopathy?
LGE amount >5% on CMR identifies hypertrophic cardiomyopathy patients at high long-term risk for sudden cardiac death, suggesting it should be added to established risk models.
Supports incorporating LGE >5% LV mass into HCM SCD risk models; leaves open need for prospective validation before practice change.
Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Robert Bosch Stiftung; Deutsche Forschungsgemeinschaft Background Sudden cardiac death (SCD) is an appalling complication of hypertrophic cardiomyopathy (HCM). There is an ongoing discussion about the optimal SCD risk stratification strategy in HCM since established SCD risk models have suboptimal discriminative power. Objective To evaluate the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for SCD risk stratification compared to the ESC SCD risk score and traditional SCD risk factors in an >10-year follow-up study. Methods 220 consecutive patients with HCM and LGE-CMR were enrolled. Follow-up data was available in 203 patients (median age 58 years, 61% male) after a median follow-up period of 10.4 years. Results LGE was present in 70% of patients with a median LGE amount of 1.6%, the median ESC 5-year SCD risk score was 1.84. In the overall cohort, SCD rates were 2.3% at 5 years, 4.8% at 10 years, and 15.7% at 15 years, independent from established risk models. A LGE amount of >5% (LV mass) portends the highest risk for SCD with SCD prevalences of 5.5% at 5 years, 13.0% at 10 years and 33.3% at 15 years. Conversely, patients with no or ≤5% LGE amount (of LV mass) have favorable prognosis. Conclusions LGE-CMR in HCM patients allows effective 10-year SCD risk stratification beyond established risk factors. LGE amount might be added to established risk models to improve its discriminatory power. Specifically, patients with >5% amount of LGE should be carefully monitored and might be adequate candidates for primary prevention ICD during the clinical long-term course. Abstract Figure.
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Seitz et al. (2021) conducted a cohort in Hypertrophic cardiomyopathy (HCM) (n=203). Late gadolinium enhancement (LGE) amount >5% of LV mass vs. No or ≤5% LGE amount was evaluated on Sudden cardiac death (SCD). In patients with hypertrophic cardiomyopathy, a late gadolinium enhancement amount >5% of LV mass was associated with a high risk of sudden cardiac death (13.0% at 10 years and 33.3% at 15 years).
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