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January 1, 2014Circulation Journal42 citationsOpen Access

Prognostic Value of Late Gadolinium Enhancement on Cardiac Magnetic Resonance Imaging in Japanese Hypertrophic Cardiomyopathy Patients

YHYasuki HenNINobuo IguchiYUYuko Utanohara

Key Result

The presence of late gadolinium enhancement on cardiac magnetic resonance imaging independently predicted cardiovascular events in Japanese patients with hypertrophic cardiomyopathy (HR 7.436).

Key Points

  • To evaluate the prognostic significance of late gadolinium enhancement on contrast-enhanced cardiovascular magnetic resonance in patients with hypertrophic cardiomyopathy.
  • Followed 345 patients with hypertrophic cardiomyopathy (mean age 59±17 years; 214 male) from a single center for a mean duration of 21.8 months.
  • Performed contrast-enhanced cardiovascular magnetic resonance (CMR) to assess late gadolinium enhancement (LGE) and cardiac structural characteristics.
  • Used multivariate analysis to identify independent predictors of adverse cardiovascular events.
  • Late gadolinium enhancement was detected in 73% (252/345) of patients, who exhibited a significantly higher annual cardiovascular event rate than LGE-negative patients (6.2%/year vs. 0.6%/year, P=0.003).
  • Multivariate analysis showed that LGE was independently associated with cardiovascular events (HR 7.436, 95% CI: 1.001–55.228, P=0.050).
  • Additional independent predictors included increased myocardial mass index (HR 1.013, 95% CI: 1.002–1.023, P=0.018), reduced left ventricular ejection fraction (HR 0.965, 95% CI: 0.945–0.985, P=0.001), and atrial fibrillation (HR 2.257, 95% CI: 1.024–4.976, P=0.043).

Study Design

Type

Cohort (n=345)

Multicenter

No

Structured PICO

Does the presence of late gadolinium enhancement on CMR predict cardiovascular events in Japanese patients with hypertrophic cardiomyopathy?

P
Population
345 Japanese patients with hypertrophic cardiomyopathy (HCM), mean age 59±17 years, 62.0% male. Key exclusions: old myocardial infarction, concurrent congenital heart disease, severe valvular disease, prior percutaneous transluminal septal myocardial ablation (PTSMA) or septal myectomy, and renal dysfunction (eGFR <30 ml/min/1.73m2).
I
Intervention
Presence of late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (CMR) imaging
C
Comparator
Absence of late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (CMR) imaging
O
Outcome
Composite of cardiovascular events (cardiac death, sudden death, aborted sudden death, sustained ventricular tachycardia, appropriate ICD discharge, unscheduled hospitalization for heart failure, stroke, or acute myocardial infarction) at mean 21.8 months follow-upcomposite

The presence of late gadolinium enhancement on CMR is an independent predictor of adverse cardiovascular events in Japanese patients with hypertrophic cardiomyopathy.

Main Result

Effect estimate: HR 7.436 (95% CI 1.001-55.228)

Absolute Event Rate: 6.2% vs 0.6%

p-value: p=0.050

Limitations

  • Retrospective, single-center study conducted in a tertiary hospital
  • Subjects did not include patients already implanted with ICD
  • LGE evaluation was conducted visually and was semi-quantitative
  • Mean follow-up period was short
  • NSVT and low blood pressure during exercise test were not included in analyses
  • Retrospective study design
  • Single-center cohort
  • Need for further prospective long-term studies

Abstract

BACKGROUND: The prognostic value of late gadolinium enhancement (LGE) on contrast-enhanced cardiovascular magnetic resonance (CMR) in Japanese hypertrophic cardiomyopathy (HCM) patients in a large, single-center cohort was investigated. METHODS AND RESULTS: A total of 345 HCM patients (mean age, 59±17 years; 214 male) underwent CMR with gadolinium enhancement, and were followed (mean duration, 21.8 months) for cardiovascular events. Patients were divided into event-positive and event-negative groups. The clinical and CMR characteristics were compared between the 2 groups, and predictors of cardiovascular events assessed on multivariate analysis. LGE was positive in 252 patients (73%). The annual cardiovascular events rate was significantly higher in patients with LGE than in those without (6.2%/year vs. 0.6%/year, P=0.003). On multivariate analysis, LGE (hazard ratio HR, 7.436; 95% confidence interval CI: 1.001-55.228, P=0.050), increased myocardial mass index (HR, 1.013; 95% CI: 1.002-1.023, P=0.018), reduced left ventricular ejection fraction (HR, 0.965; 95% CI: 0.945-0.985, P=0.001), and atrial fibrillation (HR, 2.257; 95% CI: 1.024-4.976, P=0.043) were significantly associated with cardiovascular events. CONCLUSIONS: The presence of LGE, increased myocardial mass index, reduced left ventricular ejection fraction and atrial fibrillation were independent predictors of adverse prognosis in Japanese HCM patients.

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Cite This Study

Hen et al. (2014) conducted a cohort in Hypertrophic cardiomyopathy (n=345). Presence of Late Gadolinium Enhancement (LGE) vs. Absence of LGE was evaluated on Cardiovascular events (HR 7.436, 95% CI 1.001-55.228, p=0.050). The presence of late gadolinium enhancement on cardiac magnetic resonance imaging independently predicted cardiovascular events in Japanese patients with hypertrophic cardiomyopathy (HR 7.436).

synapsesocial.com/papers/6a08db83afc616802fe4adc8https://doi.org/10.1253/circj.cj-13-0979
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