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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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Assessment of late gadolinium enhancement in hypertrophic cardiomyopathy improves risk stratification based on

Jiaxin Wang1, Shujuan Yang1, Xuan Ma1

  • 1MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.

European Heart Journal
|October 5, 2023
PubMed

Insights

The 2022 European Society of Cardiology (ESC) model improves sudden cardiac death (SCD) prediction in hypertrophic cardiomyopathy (HCM) patients. Late gadolinium enhancement (LGE) further refines risk stratification for implantable cardioverter defibrillator (ICD) candidacy.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Risk Stratification

Background:

  • Identifying hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) is critical for implantable cardioverter defibrillator (ICD) implantation.
  • Current risk stratification models require external validation and refinement.

Purpose of the Study:

  • To externally validate the 2022 European Society of Cardiology (ESC) model for SCD risk prediction in HCM.
  • To compare the performance of the 2022 ESC model against previous guidelines and assess the utility of late gadolinium enhancement (LGE) for risk stratification.

Main Methods:

  • Retrospective enrollment of 774 consecutive patients who underwent cardiac magnetic resonance imaging.
  • Validation of multiple guideline-based ICD class of recommendation (ICD-COR) models, including the 2022 ESC model.
  • Analysis of SCD events, ESC Risk-SCD scores, and LGE extent during a mean follow-up of 7.4 years.

Main Results:

  • The 2022 ESC model demonstrated superior performance (C-statistic 0.78) compared to the 2014 ESC model (C-statistic 0.64) for SCD prediction.
  • Late gadolinium enhancement (LGE) ≥5% significantly increased SCD risk (seven-fold) in patients without extensive LGE.
  • Patients with LGE ≥5% and <15% showed significantly worse prognosis across ICD-COR II and III categories.

Conclusions:

  • The 2022 ESC model offers improved sensitivity and accuracy for SCD risk prediction in HCM patients compared to the 2014 ESC model.
  • Late gadolinium enhancement (LGE) provides valuable additional information for refining risk stratification and guiding ICD implantation decisions in HCM.
Abstract

Keywords:
Hypertrophic cardiomyopathycardiac magnetic resonanceimplantable cardioverter defibrillatorlate gadolinium enhancementsudden cardiac death

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