What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy (n=237). Intervention: Extensive late gadolinium enhancement (score ≥4) vs. Without extensive LGE. Primary outcome: Life-threatening arrhythmic events (HR 5.650, 95% CI 1.263-25.000, p=0.024).

What does this research mean for the field?

Extensive late gadolinium enhancement independently predicts life-threatening arrhythmic events in hypertrophic cardiomyopathy patients, and high signal intensity on T2-weighted MRI provides further risk stratification for these events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2018Open Access

High Signal Intensity on T2-Weighted Cardiovascular Magnetic Resonance Imaging Predicts Life-Threatening Arrhythmic Events in Hypertrophic Cardiomyopathy Patients

Key Result

Extensive late gadolinium enhancement independently predicted life-threatening arrhythmic events in HCM patients (HR 5.650; 95% CI 1.263-25.000; P=0.024), with T2 high signal further stratifying risk.

Study Design

Type

Cohort (n=237)

Multicenter

Structured PICO

Does high signal intensity on T2-weighted CMR predict life-threatening arrhythmic events in patients with hypertrophic cardiomyopathy?

Population

237 patients with hypertrophic cardiomyopathy (HCM) defined as LV wall thickness ≥15 mm, median age 62 years, 60.3% male, from a single center in Japan. Excluded: old MI, concurrent congenital heart disease, severe valvular disease, and prior percutaneous transluminal septal myocardial ablation (PTSMA) or septal myectomy.

Intervention

Presence of high signal intensity on T2-weighted cardiovascular magnetic resonance imaging (T2 high signal) and/or extensive late gadolinium enhancement (LGE score ≥4)

Comparator

Absence of T2 high signal and/or absence of extensive late gadolinium enhancement

Outcome

Life-threatening arrhythmic events (composite of sudden death, aborted sudden death, sustained ventricular tachycardia/ventricular fibrillation, or appropriate ICD discharge for VT/VF) at median 3.4 years follow-uphard clinical

The presence of high signal intensity on T2-weighted CMR, particularly in combination with extensive late gadolinium enhancement, independently predicts life-threatening arrhythmic events in patients with hypertrophic cardiomyopathy.

Main Result

Effect estimate: HR 5.650 (95% CI 1.263-25.000)

Absolute Event Rate: 3% vs 0.5%

p-value: p=0.024

Abstract

BACKGROUND: The prognostic value of high signal intensity on T2-weighted cardiovascular magnetic resonance imaging (T2 high signal) in hypertrophic cardiomyopathy (HCM) patients in a single-center cohort was investigated. METHODS AND RESULTS: A total of 237 HCM patients (median age, 62 years; 143 male) underwent T2-weighted, cine and late gadolinium enhancement (LGE) imaging, and were followed (median duration, 3.4 years) for life-threatening arrhythmic events. The clinical and magnetic resonance imaging characteristics were extracted, and predictors of life-threatening arrhythmic events were assessed on multivariate analysis. LGE was present in 180 patients (75.9%). Median LGE score was 3 in a left ventricle 17-segment model. T2 high signal was present in 49 patients (20.7%). The annual events rate was significantly higher in patients with extensive LGE (score ≥4) than in those without (3.0%/year vs. 0.5%/year, P=0.011). On multivariate analysis, extensive LGE (hazard ratio, 5.650; 95% CI: 1.263-25.000, P=0.024) as an independent predictor for life-threatening arrhythmic events. In patients with extensive LGE, the annual events rate was significantly higher in patients with T2 high signal than in those without (5.8%/year vs. 0.9%/year, P=0.008). CONCLUSIONS: Extensive LGE was an independent predictor of life-threatening arrhythmic events in HCM patients. Furthermore, T2 high signal is useful for the risk stratification of serious arrhythmic events in patients with extensive LGE.

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