Key result
Late gadolinium enhancement ≥10% vs 0% in HCM was independently associated with higher risk of death, appropriate ICD discharge, or heart transplant (HR 1.59, 95% CI 1.18–2.16; p=0.003).
Why the study?
Late gadolinium enhancement on CMR has been associated with adverse outcomes in hypertrophic cardiomyopathy, and this study sought to measure its incremental prognostic value beyond established clinical and phenotypic variables in a large contemporary cohort.
Does late gadolinium enhancement (>=10% of LV mass) on cardiac magnetic resonance predict the composite outcome of mortality, appropriate ICD discharge, or heart transplantation in patients with hypertrophic cardiomyopathy and LVEF >=50%?
Cohort (n=3,035)
Does late gadolinium enhancement (>=10% of LV mass) on cardiac magnetic resonance predict the composite outcome of mortality, appropriate ICD discharge, or heart transplantation in patients with hypertrophic cardiomyopathy and LVEF >=50%?
In a large contemporary cohort of patients with hypertrophic cardiomyopathy and preserved ejection fraction, quantitative late gadolinium enhancement of >=10% on cardiac magnetic resonance independently predicts long-term mortality, appropriate ICD discharge, or heart transplantation, providing incremental prognostic value beyond established clinical risk factors.
Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) reflects myocardial fibrosis and has been associated with adverse outcomes in hypertrophic cardiomyopathy (HCM). We sought to measure its incremental prognostic value beyond established clinical and phenotypic variables in a large contemporary HCM cohort. We studied 3,035 consecutive patients (between 2002-2021) with HCM and ejection fraction (EF) ≥ 50% undergoing CMR with quantification of LGE as percent left ventricular (LV) mass (using a threshold of 6 standard deviations above normal myocardium). LGE was analyzed both as a continuous and categorical variable on phase-sensitive inversion recovery short-axis left ventricular images and quantified using a signal intensity threshold of ≥6 standard deviations above the mean of reference myocardium into three subgroups.(0%, 0.1–9.9%, ≥10%). The primary endpoint was a composite of mortality, appropriate internal cardioverter defibrillator (ICD) discharge, or heart transplantation. Baseline characteristics are shown in Figure 1A. Median follow-up was 8.8 (5.1–12.3) years. The composite endpoint occurred in 484 (16%) patients (of which 441 (14.5%) was mortality, 36 (1.2%) was appropriate ICD discharge and 7 (0.2%) was heart transplantation. LGE was present in 1703 (56%) of patients; 242 (8%) had ≥10% LGE. On multivariable Cox proportional hazards analysis, adjusted for age, sex, obstructive status (nonobstructive, obstructive without septal reduction therapy [SRT], and obstructive with SRT), hypertension, diabetes, LV ejection fraction, family history of HCM, family history of sudden cardiac death, beta-blocker use, and New York Heart Association (NYHA) Class, the following variables remained statistically significant (Hazard ratio or HR and [95% confidence interval or CI], all p<0.01): higher age (1.06 [1.05-1.07], male sex (HR 0.75 [0.61-0.93]), hypertension (1.38 [1.09-1.75]), NYHA Class ≥II vs. I (1.53 [1.18-1.99]), obstructive HCM with septal reduction therapy (0.65 [0.50-0.86]) and higher % LGE (1.04 [1.02-1.06]). Compared with no LGE, LGE ≥10% was associated with higher risk of the composite endpoint (HR 1.59, 95% CI 1.18–2.16; p=0.003), whereas 0.1–9.9% LGE showed a nonsignificant trend (HR 1.18, 95% CI 0.98–1.43; p=0.084, Figure 1B). In this contemporary HCM cohort, %LGE was independently associated with long-term adverse outcomes. A threshold of 10% of quantitative LGE provides incremental prognostic information and may refine risk stratification in HCM.
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Sheashaa et al. (2026) conducted a cohort in Hypertrophic cardiomyopathy (n=3,035). Late gadolinium enhancement (LGE) ≥10% of left ventricular mass on CMR vs. No late gadolinium enhancement (0% LGE) was evaluated on Composite of mortality, appropriate internal cardioverter defibrillator (ICD) discharge, or heart transplantation (HR 1.59, 95% CI 1.18-2.16, p=0.003). Late gadolinium enhancement ≥10% vs 0% in HCM was independently associated with higher risk of death, appropriate ICD discharge, or heart transplant (HR 1.59, 95% CI 1.18–2.16; p=0.003).
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