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Serial Myocardial Fibrosis Assessments Predict Outcomes in Patients With Hypertrophic Cardiomyopathy

Yun Tang1, Xingrui Chen1, Kankan Zhao2

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

JACC. Cardiovascular Imaging
|February 18, 2026
PubMed

Insights

Serial cardiac magnetic resonance (CMR) assessments reveal that myocardial fibrosis progression in hypertrophic cardiomyopathy (HCM) predicts adverse outcomes. This fibrosis increase, measured as ΔLGE mass/y, aids in improving risk stratification for HCM patients.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Fibrosis Research

Background:

  • The prognostic significance of tracking myocardial fibrosis over time in hypertrophic cardiomyopathy (HCM) is not well-established.
  • Serial assessments of myocardial fibrosis using late gadolinium enhancement (LGE) via cardiac magnetic resonance (CMR) are needed.

Purpose of the Study:

  • To evaluate the progression of late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) patients using serial cardiac magnetic resonance (CMR) imaging.
  • To determine the prognostic value of LGE progression in predicting adverse clinical events in HCM.

Main Methods:

  • Retrospective analysis of 313 HCM patients with two CMR studies between 2010-2019.
  • Quantified LGE mass progression (ΔLGE mass/y) and assessed its association with primary (mortality, transplantation, aborted SCD, HF hospitalization, stroke) and secondary (mortality, transplantation, aborted SCD) endpoints.
  • Utilized maximally selected rank statistics and multivariable Cox regression for analysis, with external validation.

Main Results:

  • Median LGE mass increased from 2.9 g to 8.3 g over a median interval of 4.2 years.
  • Optimal cutoffs for ΔLGE mass/y predicting primary and secondary endpoints were >1.50 g/y and >3.75 g/y, respectively.
  • ΔLGE mass/y >1.50 g/year independently predicted the primary endpoint (HR: 2.22), improving model discrimination and risk reclassification (C-statistic 0.81 to 0.84).

Conclusions:

  • Myocardial fibrosis demonstrably increases over time in patients with HCM.
  • Serial LGE assessment by CMR offers valuable prognostic information.
  • Integrating serial LGE data into CMR assessments can enhance risk stratification and guide clinical decisions in HCM management.
Abstract

Keywords:
cardiac magnetic resonanceheart failurehypertrophic cardiomyopathylate gadolinium enhancementmyocardial fibrosissudden cardiac death

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