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Prognostic Impact of LGE Granularity Using CMR in End‑Stage Hypertrophic Cardiomyopathy
Julien Hudelo1,2,3,4,5, Jérôme Garot4,6, Solenn Toupin2,3,4,5
1Department of Cardiology, Amiens University Hospital, France (J.H., C.T., A.H., Y.B.).
Circulation. Cardiovascular Imaging
|May 22, 2026
Summary
Late gadolinium enhancement (LGE) features in end-stage hypertrophic cardiomyopathy (HCM) predict mortality. The LGE granularity model, including extent, location, and pattern, offers strong prognostic value in these advanced cases.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- End-stage hypertrophic cardiomyopathy (HCM) is characterized by reduced left ventricular ejection fraction (<50%) and poor prognosis.
- Limited evidence exists on the prognostic significance of late gadolinium enhancement (LGE) features in end-stage HCM.
- Assessing the prognostic relevance of LGE granularity, including its location, extent, and pattern, is crucial for risk stratification.
Purpose of the Study:
- To evaluate the prognostic value of the LGE granularity model in patients with end-stage HCM.
- To determine the independent association of LGE extent, location, and pattern with all-cause mortality.
- To investigate the predictive power of LGE features beyond classical prognostic factors.
Main Methods:
- Retrospective analysis of 691 patients with end-stage HCM from 3 French tertiary university hospitals (2008-2024).
- Cardiovascular magnetic resonance (CMR) assessment including LGE analysis.
- The LGE granularity model combined LGE extent (unique vs. multiple), location (septal vs. other), and pattern (subepicardial vs. midwall).
- Primary endpoint was all-cause mortality, with a median follow-up of 9 years.
Main Results:
- LGE was present in 37% of patients and independently associated with mortality (HR, 1.52; P=0.02).
- Each component of the LGE granularity model showed independent prognostic value: extent (HR, 2.85; P=0.02), septal location (HR, 1.73; P<0.001), and midwall pattern (HR, 4.15; P<0.001).
- The LGE granularity model demonstrated significant predictive power for all-cause mortality in end-stage HCM.
Conclusions:
- The LGE granularity model, integrating extent, location, and pattern, provides strong and independent prognostic value in end-stage HCM.
- These findings highlight the importance of detailed LGE assessment for risk stratification in advanced HCM.
- The LGE granularity model can aid in identifying high-risk patients requiring closer monitoring and tailored management strategies.
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