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Late Gadolinium Enhancement in Patients With Hypertrophic Cardiomyopathy and Preserved Systolic Function

Amgad Mentias1, Pejman Raeisi-Giglou1, Nicholas G Smedira1

  • 1Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

Journal of the American College of Cardiology
|August 18, 2018
PubMed

Insights

Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) provides significant prognostic value in hypertrophic cardiomyopathy (HCM) patients. This finding aids in risk stratification for sudden cardiac death (SCD) and appropriate implantable cardioverter-defibrillator discharge.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Genetics

Background:

  • Hypertrophic cardiomyopathy (HCM) frequently exhibits late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging.
  • LGE indicates myocardial scarring and fibrosis, which are implicated in adverse outcomes.

Purpose of the Study:

  • To evaluate the additional prognostic information provided by LGE in patients diagnosed with HCM.
  • To assess the association of LGE with adverse cardiovascular events in different HCM subgroups.

Main Methods:

  • A cohort of 1,423 low- to intermediate-risk adult HCM patients with preserved ejection fraction were analyzed.
  • Transthoracic echocardiography (TTE) and CMR with LGE quantification were performed.
  • The primary endpoint was a composite of sudden cardiac death (SCD) and appropriate implantable cardioverter-defibrillator (ICD) discharge over a 5-year period.

Main Results:

  • Fifty percent of patients showed LGE on CMR, with a median of 8.4%.
  • LGE ≥15% was associated with an increased risk of composite events.
  • In obstructive HCM, ≥15% LGE increased event rates, while myectomy reduced them.
  • LGE improved risk prediction models, demonstrating incremental prognostic utility.

Conclusions:

  • In low-/intermediate-risk HCM patients, LGE provides significant incremental prognostic value for adverse cardiovascular events.
  • LGE assessment is crucial for risk stratification in obstructive, nonobstructive, and post-myectomy HCM subgroups.
  • These findings support the integration of LGE into clinical risk assessment protocols for HCM.
Abstract

Keywords:
cardiac magnetic resonancehypertrophic cardiomyopathyrisk stratification

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