Myocardial Entropy and Risk Predictors in Hypertrophic Cardiomyopathy: An Analysis From the NHLBI HCM Registry
Panagiotis Antiochos1,2, Yin Ge1, Michael Jerosch-Herold1
1Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.A., Y.G., M.J.-H., L.-P.D., C.Y.H., R.Y.K.).
Circulation. Cardiovascular Imaging
|September 24, 2025
Summary
Left ventricular (LV) entropy, a novel measure in hypertrophic cardiomyopathy (HCM), correlates with adverse outcomes and predicts ventricular tachycardia. This imaging biomarker offers valuable clinical insights for HCM patient risk stratification.
Area of Science:
- Cardiology
- Biomedical Imaging
- Biomarkers
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex genetic heart disease.
- Assessing risk predictors in HCM is crucial for patient management.
- Novel imaging biomarkers are needed to improve risk stratification.
Purpose of the Study:
- To investigate the associations of left ventricular (LV) entropy with risk predictors in patients with HCM.
- To determine if LV entropy can predict adverse outcomes in HCM.
- To evaluate the clinical utility of LV entropy in HCM patient care.
Main Methods:
- LV entropy was calculated from cardiovascular magnetic resonance imaging (CMR) using pixel signal intensities of the LV myocardium.
- Entropy values were correlated with demographic, genetic, imaging, and serum biomarkers.
- Associations with European Society of Cardiology (ESC) risk score and Holter recordings were analyzed.
Main Results:
- LV entropy showed significant associations with sarcomere mutations, ventricular tachycardia, atrial fibrillation, elevated cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
- LV entropy correlated with increased LV wall thickness, LGE presence/extent, extracellular volume, atrial size/function, and myocardial strain.
- LV entropy was the strongest predictor of ventricular tachycardia on Holter, independent of LGE presence.
Conclusions:
- LV entropy is associated with clinical, imaging, and biological predictors of adverse outcomes in HCM.
- LV entropy provides valuable prognostic information, independent of LGE.
- LV entropy is a powerful predictor of ventricular tachycardia in HCM patients.
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