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Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy.

Publication ,  Journal Article
Chan, RH; Maron, BJ; Olivotto, I; Pencina, MJ; Assenza, GE; Haas, T; Lesser, JR; Gruner, C; Crean, AM; Rakowski, H; Udelson, JE; Rowin, E ...
Published in: Circulation
August 5, 2014

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden death in the young, although not all patients eligible for sudden death prevention with an implantable cardioverter-defibrillator are identified. Contrast-enhanced cardiovascular magnetic resonance with late gadolinium enhancement (LGE) has emerged as an in vivo marker of myocardial fibrosis, although its role in stratifying sudden death risk in subgroups of HCM patients remains incompletely understood. METHODS AND RESULTS: We assessed the relation between LGE and cardiovascular outcomes in 1293 HCM patients referred for cardiovascular magnetic resonance and followed up for a median of 3.3 years. Sudden cardiac death (SCD) events (including appropriate defibrillator interventions) occurred in 37 patients (3%). A continuous relationship was evident between LGE by percent left ventricular mass and SCD event risk in HCM patients (P=0.001). Extent of LGE was associated with an increased risk of SCD events (adjusted hazard ratio, 1.46/10% increase in LGE; P=0.002), even after adjustment for other relevant disease variables. LGE of ≥15% of LV mass demonstrated a 2-fold increase in SCD event risk in those patients otherwise considered to be at lower risk, with an estimated likelihood for SCD events of 6% at 5 years. Performance of the SCD event risk model was enhanced by LGE (net reclassification index, 12.9%; 95% confidence interval, 0.3-38.3). Absence of LGE was associated with lower risk for SCD events (adjusted hazard ratio, 0.39; P=0.02). Extent of LGE also predicted the development of end-stage HCM with systolic dysfunction (adjusted hazard ratio, 1.80/10% increase in LGE; P<0.03). CONCLUSIONS: Extensive LGE measured by quantitative contrast enhanced CMR provides additional information for assessing SCD event risk among HCM patients, particularly patients otherwise judged to be at low risk.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 5, 2014

Volume

130

Issue

6

Start / End Page

484 / 495

Location

United States

Related Subject Headings

  • Young Adult
  • Single-Blind Method
  • Risk Factors
  • Prognosis
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine
  • Humans
  • Gadolinium
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Chan, R. H., Maron, B. J., Olivotto, I., Pencina, M. J., Assenza, G. E., Haas, T., … Maron, M. S. (2014). Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation, 130(6), 484–495. https://doi.org/10.1161/CIRCULATIONAHA.113.007094
Chan, Raymond H., Barry J. Maron, Iacopo Olivotto, Michael J. Pencina, Gabriele Egidy Assenza, Tammy Haas, John R. Lesser, et al. “Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy.Circulation 130, no. 6 (August 5, 2014): 484–95. https://doi.org/10.1161/CIRCULATIONAHA.113.007094.
Chan, Raymond H., et al. “Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy.Circulation, vol. 130, no. 6, Aug. 2014, pp. 484–95. Pubmed, doi:10.1161/CIRCULATIONAHA.113.007094.
Chan RH, Maron BJ, Olivotto I, Pencina MJ, Assenza GE, Haas T, Lesser JR, Gruner C, Crean AM, Rakowski H, Udelson JE, Rowin E, Lombardi M, Cecchi F, Tomberli B, Spirito P, Formisano F, Biagini E, Rapezzi C, De Cecco CN, Autore C, Cook EF, Hong SN, Gibson CM, Manning WJ, Appelbaum E, Maron MS. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation. 2014 Aug 5;130(6):484–495.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 5, 2014

Volume

130

Issue

6

Start / End Page

484 / 495

Location

United States

Related Subject Headings

  • Young Adult
  • Single-Blind Method
  • Risk Factors
  • Prognosis
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine
  • Humans
  • Gadolinium
  • Female