- Oral presentation
- Open Access
Late gadolinium enhancement cardiovascular magnetic resonance for sudden cardiac death risk stratification in hypertrophic cardiomyopathy
© Ismail et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Leave Ventricular Ejection Fraction
- Cardiovascular Magnetic Resonance
- Sudden Cardiac Death
- Late Gadolinium Enhancement
- Hypertrophic Cardiomyopathy
Although myocardial fibrosis identified by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) may predict adverse outcomes among patients with hypertrophic cardiomyopathy (HCM), its precise role in risk stratification for sudden cardiac death (SCD) remains unresolved. Previous studies have relied on broad surrogate composite endpoints and were underpowered to assess SCD risk or to adjust for confounding variables. To address this, we studied the prognostic significance of LGE in a large HCM cohort with long-term follow-up.
Consecutive patients with HCM (n=711, median age 56.3 years, interquartile range [IQR] 46.7 to 66.6; 70.0% male) underwent LGE-CMR and were prospectively followed for a median of 3.5 years. This amounted to a total of 2852 patient-years of follow-up. The primary endpoint was SCD or aborted SCD. The principal secondary endpoint was a composite of cardiovascular mortality and aborted SCD. LGE imaging was performed in two orthogonal phase-encoding directions ~10 min after 0.1 mmol/kg gadolinium using an inversion recovery-prepared gradient echo sequence. The amount was quantified using the full-width at half-maximum method.
No LGE (n=240 [33.8%])
LGE (n=471 [66.2%)
All patients (n=711)
LV-EDV index - ml/m 2
LV-ESV index - ml/m 2
LV ejection fraction - %
LV mass index - g/m 2
Maximum end-diastolic wall thickness - mm
Neither the presence nor the amount of LGE independently predicted SCD risk after adjusting for confounders. In contrast, LV-EF was the best independent predictor of SCD and cardiovascular mortality, and should therefore be considered as part of the routine risk stratification of patients with HCM.
This work is supported by the NIHR Cardiovascular Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust, and Imperial College. Dr Ismail is supported by the British Heart Foundation.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.