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Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy using cardiovascular magnetic resonance

  • Rory O'Hanlon1,
  • Agata Grasso1,
  • Michael Roughton2,
  • James C Moon3,
  • Susan Clarke1,
  • Ricardo Wage1,
  • Jess Webb1,
  • Meghana Kulkarni1,
  • Dana Dawson1,
  • Leena Sulaibeekh1,
  • Bud Chandrasekaran1,
  • Chiara Bucciarelli-Ducci1,
  • Ferdinando Pasquale3,
  • Martin R Cowie4,
  • Wiliam J McKenna3,
  • Margaret Burke5,
  • Mary Sheppard1,
  • Perry M Elliot3,
  • Dudley J Pennell1 and
  • Sanjay K Prasad1
Journal of Cardiovascular Magnetic Resonance201012(Suppl 1):O50

Published: 21 January 2010


Heart FailureCardiovascular Magnetic ResonancePrognostic SignificanceHypertrophic CardiomyopathyCardiovascular Death


The role of myocardial fibrosis in the prediction of sudden death and heart failure in hypertrophic cardiomyopathy (HCM) is unclear.


We sought to investigate the prognostic significance of fibrosis detection by cardiovascular magnetic resonance (CMR) to predict major clinical events in HCM using the late gadolinium-enhanced (LGE) technique.


A prospective cohort study of 217 consecutive HCM patients followed for 3.1 + 1.7 years to determine the role of fibrosis detected using LGE-CMR on morbidity and mortality.


LGE was present in 136/217 (LGE+, 63%). Thirty four of the 136 patients (25%) in the LGE+ group and 6/81 (7.4%) in the LGE- group reached the combined primary endpoint of cardiovascular death, unplanned cardiovascular admission, sustained VT/VF, or appropriate ICD discharge, (HR 3.4, p = 0.006). In the LGE+ group, overall risk increased with the percentage of LGE present (HR 1.03 per percent LGE increase, p = 0.008). The risk of unplanned heart failure admissions, deterioration to NYHA III or IV, or heart failure related death was greater in LGE+ group (HR 2.5, p = 0.021), and this risk increased as the percentage of LGE increased (HR 1.03 per percent LGE increase, p = 0.017). All relationships remained significant after multivariate analysis. The overall percentage of LGE was an important univariate predictor for arrhythmic endpoints (sustained VT/VF, appropriate ICD discharge, SCD), HR 1.05 per percent LGE increase, p = 0.014), but did not reach significance after multivariate analysis.


In patients with HCM, myocardial fibrosis is an independent predictor of adverse outcome particularly due to heart failure

Authors’ Affiliations

Royal Brompton Hospital, London, UK
R-Squared Statistics, London, UK
The Heart Hospital, London, UK
Imperial College, London, UK
Harefield Hospital, London, UK


© O'Hanlon et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.