A Global Dispersion Score >0.86 on LGE-dispersion mapping independently predicted hard cardiac events in patients with hypertrophic cardiomyopathy (HR 9.9; 95% CI 2.9-34.6; P=0.0003).
Cohort (n=183)
Does LGE-dispersion mapping improve risk stratification for hard cardiac events compared to LGE extent in patients with hypertrophic cardiomyopathy?
LGE-dispersion mapping is a novel marker of scar heterogeneity that improves sudden cardiac death risk stratification beyond simple LGE extent in hypertrophic cardiomyopathy.
Hazard Ratio: 9.9 (95% CI 2.9–34.6)
p-value: p=0.0003
Background: Late gadolinium enhancement (LGE) is an important prognostic marker in hypertrophic cardiomyopathy and an extent >15% it is associated with high risk of sudden cardiac death. We proposed a novel method, the LGE-dispersion mapping, to assess heterogeneity of scar, and evaluated its prognostic role in patients with hypertrophic cardiomyopathy. Methods: One hundred eighty-three patients with hypertrophic cardiomyopathy and a low- or intermediate 5-year risk of sudden cardiac death underwent cardiac magnetic resonance imaging. A parametric map was generated from each LGE image. A score from 0 to 8 was assigned at every pixel of these maps, indicating the number of the surrounding pixels having different quality (nonenhancement, mild-enhancement, or hyperenhancement) from the central pixel. The Global Dispersion Score (GDS) was calculated as the average score of all the pixels of the images. Results: During a median follow-up time of 6 (25th–75th, 4–10) years, 22 patients had hard cardiac events (sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, resuscitated cardiac arrest, and sustained ventricular tachycardia). Kaplan-Meier analysis showed that patients with GDS>0.86 had worse prognosis than those with lower GDS ( P 0.86 was the only independent predictor of cardiac events (hazard ratio, 9.9 95% CI, 2.9–34.6, P =0.0003). When compared with LGE extent >15%, GDS improved the classification of risk in these patients (net reclassification improvement, 0.39 95% CI, 0.11–0.72, P <0.019). Conclusions: LGE-dispersion mapping is a marker of scar heterogeneity and provides a better risk stratification than LGE presence and its extent in patients with hypertrophic cardiomyopathy and a low-intermediate 5-year risk of sudden cardiac death.
Aquaro et al. (Mon,) conducted a cohort in hypertrophic cardiomyopathy (n=183). Global Dispersion Score (GDS) >0.86 vs. lower GDS was evaluated on hard cardiac events (sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, resuscitated cardiac arrest, and sustained ventricular tachycardia) (HR 9.9, 95% CI 2.9-34.6, p=0.0003). A Global Dispersion Score >0.86 on LGE-dispersion mapping independently predicted hard cardiac events in patients with hypertrophic cardiomyopathy (HR 9.9; 95% CI 2.9-34.6; P=0.0003).