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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
PubMed

Insights

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.
Abstract

Keywords:
cardiomyopathy, hypertrophicgadoliniumhumansmagnetic resonance imagingprognosisstroke volumeventricular function, left

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