In patients with hypertrophic cardiomyopathy, extensive LGE (≥15%) was associated with over 3-fold higher risk of sudden death compared to those with <15% or no LGE (OR 3.52).
Does the extent of late gadolinium enhancement on CMR predict adverse clinical outcomes in patients with hypertrophic cardiomyopathy?
The extent of late gadolinium enhancement (≥15%), rather than its mere presence, is an independent predictor of sudden death and adverse events in patients with hypertrophic cardiomyopathy.
Background: Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) has emerged as a potential marker for risk of adverse events in patients with hypertrophic cardiomyopathy (HCM). However, previous studies have been limited to small cohorts with short follow-up periods and therefore the clinical significance of LGE in HCM remains uncertain.Methods: Cine and contrast-enhanced CMR were performed on 594 HCM patients (4916 years; 65 males). CMR scans were analyzed at a single data coordinating center. Mean follow-up was 3.5 1.4 years.Results: LGE was identified in 235 (40) patients, occupying 10 11 of LV myocardial volume. There was no statistically significant relationship between presence of LGE and a number of clinical end-points including all HCM-related adverse disease events (OR 1.64, 95 CI 0.99-2.70, p0.05), progression to NYHA class III or IV or death from heart failure or stroke (OR 1.42, 95CI 0.78-2.51, p=0.24), or sudden death (OR 1.89, 95 CI 0.78-4.55, p=0.16). However, when LGE was present a significant linear relation was evident between the extent of LGE and risk of progressive heart failure symptoms/cardiovascular death (OR 1.17/5 LGE, 95 CI 1.04-1.32; p0.01) and sudden death (OR 1.20/5 LGE, 95CI 1.04-1.40 p=0.016). HCM patients with extensive LGE 15 were at more than 3-fold higher risk of sudden death compared to patients with 15 or no LGE (OR 3.52, 95CI 1.23-10.08, p=0.019). Multivariable analysis confirmed that extent of LGE was independently associated with an increased risk of sudden death (adj. OR 1.25/5 increase, p=0.02), even after controlling for traditional sudden death risk factors. The absence of LGE trended towards a low likelihood of experiencing HCM-related adverse events (adj. OR 0.59, 95 CI 0.34-0.99, p=0.052).Conclusion: In patients with HCM, the amount of LGE (but not presence) was associated with an increased risk of HCM-related adverse events, including sudden death. Extensive LGE may represent a risk marker with the potential to arbitrate ambiguous decisions regarding ICD therapy. The absence of LGE is consistent with lower risk status and can be used to reassure patients.
Chan et al. (2012) studied this question. In patients with hypertrophic cardiomyopathy, extensive LGE (≥15%) was associated with over 3-fold higher risk of sudden death compared to those with <15% or no LGE (OR 3.52).
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