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1. Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy: the role of myocardial replacement fibrosis and the microcirculation

Author

Claire E. Raphael, Frances Mitchell, Gajen Sunthar Kanaganayagam, Alphonsus C. Liew, Elisa Di Pietro, Miguel Silva Vieira, Lina Kanapeckaite, Simon Newsome, John Gregson, Ruth Owen, Li-Yueh Hsu, Vassilis Vassiliou, Robert Cooper, Aamir Ali MRCP, Tevfik F. Ismail, Brandon Wong, Kristi Sun, Peter Gatehouse, David Firmin, Stuart Cook, Michael Frenneaux, Andrew Arai, Rory O’Hanlon, Dudley J. Pennell, and Sanjay K. Prasad

Subjects
Hypertrophic cardiomyopathy, Heart failure, Prognosis, Cardiovascular magnetic resonance, Fibrosis, Microvascular ischemia, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Introduction Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational cohort study. Methods Serial patients with HCM underwent CMR, including adenosine first-pass perfusion, left atrial (LA) and left ventricular (LV) volumes indexed to body surface area (i) and late gadolinium enhancement (%LGE- as a % of total myocardial mass). We used a composite endpoint of HF death, cardiac transplantation, and progression to NYHA class III/IV. Results A total of 543 patients with HCM underwent CMR, of whom 94 met the composite endpoint at baseline. The remaining 449 patients were followed for a median of 5.6 years. Thirty nine patients (8.7%) reached the composite endpoint of HF death (n = 7), cardiac transplantation (n = 2) and progression to NYHA class III/IV (n = 20). The annual incidence of HF was 2.0 per 100 person-years, 95% CI (1.6–2.6). Age, previous non-sustained ventricular tachycardia, LV end-systolic volume indexed to body surface area (LVESVI), LA volume index ; LV ejection fraction, %LGE and presence of mitral regurgitation were significant univariable predictors of HF, with LVESVI (Hazard ratio (HR) 1.44, 95% confidence interval (95% CI) 1.16–1.78, p = 0.001), %LGE per 10% (HR 1.44, 95%CI 1.14–1.82, p = 0.002) age (HR 1.37, 95% CI 1.06–1.77, p = 0.02) and mitral regurgitation (HR 2.6, p = 0.02) remaining independently predictive on multivariable analysis. The presence or extent of inducible perfusion defect assessed using a visual score did not predict outcome (p = 0.16, p = 0.27 respectively). Discussion The annual incidence of HF in a contemporary ambulatory HCM population undergoing CMR is low. Myocardial fibrosis and LVESVI are strongly predictive of future HF, however CMR visual assessment of myocardial perfusion was not.

Published
2021
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2. Precision Phenotyping of Dilated Cardiomyopathy Using Multidimensional Data

Author

Upasana Tayal, Job A.J. Verdonschot, Mark R. Hazebroek, James Howard, John Gregson, Simon Newsome, Ankur Gulati, Chee Jian Pua, Brian P. Halliday, Amrit S. Lota, Rachel J. Buchan, Nicola Whiffin, Lina Kanapeckaite, Resham Baruah, Julian W.E. Jarman, Declan P. O’Regan, Paul J.R. Barton, James S. Ware, Dudley J. Pennell, Bouke P. Adriaans, Sebastiaan C.A.M. Bekkers, Jackie Donovan, Michael Frenneaux, Leslie T. Cooper, James L. Januzzi, John G.F. Cleland, Stuart A. Cook, Rahul C. Deo, Stephane R.B. Heymans, Sanjay K. Prasad, RS: Carim - H02 Cardiomyopathy, Cardiologie, MUMC+: MA Med Staf Artsass Cardiologie (9), RS: Carim - B06 Imaging, RS: Carim - H01 Clinical atrial fibrillation, MUMC+: MA Cardiologie (9), MUMC+: MA Med Staf Spec Cardiologie (9), FONDATION LEDUCQ, and Imperial College Healthcare NHS Trust- BRC Funding

Subjects
Cardiomyopathy, Dilated, Male, Proteomics, Cardiac & Cardiovascular Systems, STRATEGIES, Cardiomyopathy, heart, 1117 Public Health and Health Services, proteomics, Humans, POSITION STATEMENT, 1102 Cardiorespiratory Medicine and Haematology, Science & Technology, Dilated/diagnosis, Stroke Volume, Middle Aged, R1, Fibrosis, machine learning, Cardiovascular System & Hematology, Creatinine, Cardiomyopathy, Dilated/diagnosis, Cardiovascular System & Cardiology, ESC WORKING GROUP, Female, Cardiology and Cardiovascular Medicine, Cardiomyopathies, Life Sciences & Biomedicine
Abstract

BACKGROUND: Dilated cardiomyopathy (DCM) is a final common manifestation of heterogenous etiologies. Adverse outcomes highlight the need for disease stratification beyond ejection fraction. OBJECTIVES: The purpose of this study was to identify novel, reproducible subphenotypes of DCM using multiparametric data for improved patient stratification. METHODS: Longitudinal, observational UK-derivation (n = 426; median age 54 years; 67% men) and Dutch-validation (n = 239; median age 56 years; 64% men) cohorts of DCM patients (enrolled 2009-2016) with clinical, genetic, cardiovascular magnetic resonance, and proteomic assessments. Machine learning with profile regression identified novel disease subtypes. Penalized multinomial logistic regression was used for validation. Nested Cox models compared novel groupings to conventional risk measures. Primary composite outcome was cardiovascular death, heart failure, or arrhythmia events (median follow-up 4 years). RESULTS: In total, 3 novel DCM subtypes were identified: profibrotic metabolic, mild nonfibrotic, and biventricular impairment. Prognosis differed between subtypes in both the derivation (P < 0.0001) and validation cohorts. The novel profibrotic metabolic subtype had more diabetes, universal myocardial fibrosis, preserved right ventricular function, and elevated creatinine. For clinical application, 5 variables were sufficient for classification (left and right ventricular end-systolic volumes, left atrial volume, myocardial fibrosis, and creatinine). Adding the novel DCM subtype improved the C-statistic from 0.60 to 0.76. Interleukin-4 receptor-alpha was identified as a novel prognostic biomarker in derivation (HR: 3.6; 95% CI: 1.9-6.5; P = 0.00002) and validation cohorts (HR: 1.94; 95% CI: 1.3-2.8; P = 0.00005). CONCLUSIONS: Three reproducible, mechanistically distinct DCM subtypes were identified using widely available clinical and biological data, adding prognostic value to traditional risk models. They may improve patient selection for novel interventions, thereby enabling precision medicine. ispartof: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY vol:79 issue:22 pages:2219-2232 ispartof: location:United States status: published

Published
2022
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3. Students' participation in collaborative research should be recognised

Author

Aditya Borakati, Kenneth McLean, Thomas M. Drake, Ewen M. Harrison, Sivesh K. Kamarajah, Chetan Khatri, Dmitri Nepogodiev, Minaam Abbas, Muhammad Abdalkoddus, Areej Abdel-Fattah, Reem Abdelgalil, Haweya Abdikadir, Ryan Adams, Sarah Adams, Inioluwa Adelaja, Abiola Adeogun, Helena Adjei, Amirul Adlan, Hussamuddin Adwan, Sara Aeyad, Raiyyan Aftab, Amir Afzul, Vani Agarwal, Hosam Aglan, Medha Agrawal, Rishi Agrawal, Fiza Ahmed, Sobia Akhtar, Onyinye Akpenyi, Maithem Al-Attar, Muhammed Al-Ausi, Waleed Al-Khyatt, Alia Al-Mousawi, Zainab Al-Nasser, Anand Alagappan, Justin Alberts, Maryam Alfa-Wali, Abdulmajid Ali, Adnan Ali, Tamara Ali, Bilal Alkhaffaf, Rachael Allen, Kassem Alubaidi, Edemanwan Andah, Richard Anderson, Kirstine Andrew, Andrew Ang, Eshen Ang, Theophilus Anyomih, James Archer, Matt Archer, Steven Arnell, Matthew Arnold, Esha Arora, Nadeem Ashraf, Raees Ashraf, Jordan Ashwood, Usama Asif, Andrew Atayi, Sameera Auckburally, Ralph Austin, Sultana Azam, Aishah Azri Yahaya, Fiyin Babatunde, Simon Bach, Roudi Bachar, Abdul Badran, Caroline Baillie, Edward Balai, Alexander Baldwin, Vartan Balian, Danielle Banfield, Jonathan Bannard-Smith, Connor Barker, Behrad Barmayehvar, Jane Barnfield, David Bartlett, Richard Bartlett, Kwaku Baryeh, Siddharth Basetti, Kellie Bateman, Michael Bath, Andrew Beamish, William Beasley, Simon Beecroft, Ardit Begaj, Gurpreet Beghal, Jessica Belchos, Katarzyna Bera, Tara Bergara, Anna Betts, Aneel Bhangu, Gayathri Bhaskaran, Amina Bhatti, Mihai Bica, Caitlin Billyard, Emily Birkin, Jane Blazeby, Harry Blege, Natalie Blencowe, Christopher Blore, Alex Boddy, Matthew Boissaud-Cooke, Anita Bolina, William Bolton, David Bosanquet, Doug Bowley, Kathryn Boyce, Graham Branagan, Jessica Brayley, Joanna Brecher, Kristina Bresges, Emily Briggs, Ryan Broll, Damien Brown, Elliot Brown, Leo Brown, Robin Brown, Rory Brown, Connor Bruce, Pepa Bruce, Rory Buckle, Emily Budd, Richard Buka, Dermot Burke, Joshua Burke, Alisha Burman, Laura Burney, Amy Burrows, Mohammed Bux, Ronan Cahill, Clementina Calabria, Julian Camilleri-Brennan, Amy Campbell, Bill Campbell, Matthew Cant, Yun Cao, Sophie Carlson, Grace Carr, Luke Carr, Rebecca Carr, Richard Carr, Eleanor Cartwright, Alice Castle, Kirsty Cattle, Daniel Cave, Stephen Chapman, Alexandros Charalabopoulos, Sanjay Chaudhri, Ahmad Chaudhry, Paresh Chauhan, Priyesh Chauhan, Ryad Chebbout, Yunzi Chen, Louisa Chenciner, Jingjie Cheng, Natalie Cheng, Lin Chew, Zenab China, Abhishek Chitnis, Praminthra Chitsabesan, Paul Choi, Sarah Choi, Mariam Choudhry, Chern Choy, Claudia Ciurleo, Henry Claireaux, Peter Coe, Simon Cole, Katy Concannon, Edward Cope, Olivia Corbridge, Jessica Court, Louise Cox, Anna Craig-Mcquaide, Ben Cresswell, Lauren Crozier, Neil Cruickshank, Lucy Cuckow, Helen Cui, Elspeth Cumber, Sarah Cumming, Olivia Cundy, Melissa Cunha, Pedro Cunha, Laura Cunliffe, Jazleen Dada, Prita Daliya, Jeffrey Dalli, Ian Daniels, James Daniels, Ahmed Daoub, Sabeera Dar, Emma Das, Kaustuv Das, Emily Davies, Gareth Davies, Kirsty Davies, Kristen Davies, Rachel Davies, Victoria Dawe, Joshua Lucas de Carvalho, Katie De Jong, Katherine Deasy, Praveena Deekonda, Sahil Deepak, Henal Desai, Karishma Desai, Ryan Devlin, Nishat Dewan, Akashdeep Dhillon, Priya Dhillon, Tanya Dhir, Salomone Di Saverio, Julia Diamond, Peter Dib, Panagiotis A. Dimitriadis, Shiva Dindyal, Matthew Doe, Ciaran Doehrty, Tara Dogra, Arpan Doshi, Alison Downey, Joseph Doyle, Ashleigh Draper, Sarah Duff, Joseph Duncumb, Sophie Dupre, Justine Durno, Michal Dzieweczynski, Nicola Eardley, Sarah Easby, Sam Easdon, Hamdi Ebdewi, Lydon Eccles, Jacob Edwards, Padma Eedarapalli, Mohamed Elbuzidi, Patrick Elder, Lucy Elliott, Malaz Elsaddig, Ysabelle Embury-Young, Sophie Emesih, Alec Engledow, William English, Christos Episkopos, Jonathan Epstein, Rahim Esmail, Taher Fatayer, Nicolò Favero, Nicola Fearnhead, Maxine Feldman, Evelyn Fennelly, Stephen Fenwick, Lucie Ferguson, Stuart Fergusson, Petros Fessas, Isabel FitzGerald, J. Edward Fitzgerald, Harry Fitzpatrick, Daniel Fletcher, Tonia Forjoe, Beniamino Forte, Alex Fowler, Benjamin France, Abraham Francis, Niroshan Francis, Sunil Francis, Sam Freeman, Vicky Fretwell, Teresa Fung, Hugh Furness, Michael Gallagher, Stuart Gallagher, Chuanyu Gao, Lothaire Garard, Shona Gardner, Andrew Gaukroger, Daniel George, Simi George, Jamal Ghaddar, Ali Ghaffar, Shamira Ghouse, Amanda Gilbert, Ashveen Gill, Francesco Giovinazzo, Carey Girling, Lolade Giwa, James Glasbey, Paul Glen, Mary Goble, Jenna Godfrey, Shreya Goel, Wenn Goh, Kajal Gohil, Shyam Gokani, David Gold, David Golding, Andrea Gonzalez-Ciscar, Ross Goodson, Melissa Gough, Shubhangi Govil, Thomas Gower, Christopher Graham, Sam Gray, Patrick Green, Samuel Greenhalgh, Kyriacos Gregoriou, Rhiannon Gribbell, Mary Catherine Gribbon, Charlotte Grieco, Emma Griffiths, Ewen Griffiths, Nathan Griffiths, Sara Griffiths, Cathleen Grossart, Daniel Guerero, Christianne Guillotte, Rishi Gupta, Claire Guy, Adam Gwozdz, James Haddow, Shazia Hafiz, Constantine Halkias, Elisabeth Hall, Hasseb Hamid, Emma Hamilton, Gurvinder Singh Harbhajan Singh, John Hardman, Rhiannon Harries, Rhydian Harris, Suzanne Harrogate, Megan Harty, Jessica Harvey, Rahima Hashemi, Ahmed Hassane, Helen Hawkins, Thomas Hawthorne, John Hayes, Phoebe Hazenberg, Harry Heath, Madhusoodhana Hebbar, R. Heer, Roisin Hegarty O'Dowd, David Henshall, Philip Herrod, Elizabeth Hester, Emily Heywood, Nick Heywood, Frances Hill, James Hill, Kirsty Hill, May Ho, Marianne Hollyman, David Holroyd, Joseph Home, Steve Hornby, Laura Horne, Charlotte Horseman, Huma Hosamuddin, Amy Hough, George Hourston, Nathan Hudson-Peacock, Belinda Hughes, Katie Hughes, Isabel Huppatz, Penelope Hurst, Mahrukh Hussain, Shoaib Fahad Hussain, Syeda Hussain, Imogen Hutchings, Bilal Ibrahim, Lema Imam, Rory Ingham, Rose Ingleton, Rizwan Iqbal, Jenny Isherwood, Abdurrahman Islim, Omar Ismail, Shashank Iyer, Toby Jackman, Prashant Jain, Nadeem Jamal, Sabine Jamal, Ellen James, Nirmitha Jayaratne, Nathan Jeffreys, Hiral Jhala, Courtney Johnson, Zoe Johnston, Conor Jones, Emma-Jane Jones, Keaton Jones, Victor Jones, Roshan Joseph, Dilan Joshi, Holly Joyce, Claire Joyner, Aditya Kale, Sagar Kanabar, Lina Kanapeckaite, Hadyn Kankam, Sarantos Kaptanis, Edward Karam, Dimitrios Karponis, Anne Karunatilleke, Veeru Kasivisvanathan, Geeta Kaur, Samina Kauser, Nigel Keelty, Denise Kelly, Jessica Kennett, Molly Kerr, Ahmed Kerwan, Apoorva Khajuria, Mostafa Khalil, Mehnoor Khaliq, Ayushah Khan, Hamzah Khan, Haroon Khan, Maaz Khan, Maria Khan, Shahab Khan, Kaywaan Khan, Rachel Khaw, Ashni Kheterpal, Parisa Khonsari, Miraen Kiandee, Samuel Kim, Suji Kim, Sung-Hee Kim, Harry King, Anna Kinsella, Ajit Kishore, Stefan Klimach, Angelos G. Kolias, Anna Kolodziejczyk, Chia Yew Kong, Tseun Han James Kong, Omar Kouli, Sebi Kukran, Sevi Kukran, Geev Kumaran, Vladislav Kutuzov, Chris Laing, Georgina Laing, Kulvinder Lal, Peter Lalor, Joel Lambert, Sai Geethan Lambotharan, Eve Lancaster, Jasmine Latter, Michelle Latter, Kenny Lau, Alexa Lazarou, Madeline Leadon, Gabriel Lee, Jeyoung Lee, Kathryn Lee, Matthew Lee, Samuel Lee, Zong Lee, Edward Leung, Thomas Lewis, Hansen Li, Mimi Li, Wan Jane Liew, Yao Ren Liew, Alexander Light, Lydia Lilis, Diana Lim, Hui Lim, Joseph Lim, Zhi Lim, Siyin Liu, James Lloyd, Andrew Logan, Priya Loganathan, M. Long, Lydia Longstaff, Luisa Lopez Rojas, Richard Lovegrove, Jack Lowe-Zinola, Byron Lu Morrell, Joshua Luck, Andreas Luhmann, Surabhika Lunawat, Jon Lund, Cong Luo, Lorna Luo, Iona Lyell, Panagis Lykoudis, Jonathan Macdonald, Aliya Mackenzie, Conor Magee, Pooja Mahankali-Rao, Kamal Mahawar, Mehreen Mahfooz, Faisal Mahmood, Samir Makwana, Tom Malik, Sohaib Mallick, Jyothis Manalayil, Tinaye Mandishona, Sudhakar Mangam, Maniragav Manimaran, Natarajan Manimaran, Chris Manson, Sufyan Mansoor, Fatima Mansour, Alejandro Marcos Rodrigo, Nicholas Markham, Maria Marks, Paul Marriott, Hannah Marsden, Laura Martin, Tiago Martins, John Mason, Luke Mason, Mariam Masood, Nikhil Math, Ginimol Mathew, Jacob Matthews, Jonathan Mayes, Ursula Mc Gee, Ross Mcallister, Sandra Mcallister, Scott Mccain, Conor Mccann, Emmet Mccann, Cathal McCarthy, Gillian Mccoll, Greg Mcconaghie, Ace Mcdermott, Frank McDermott, Rachel Mcdougall, Mark McDowell, Gordon McFarlane, Richard McGregor, Doug McKechnie, Jillian McKenna, Scott McKinstry, Georgia Mclachlan, E. Mclean, Elizabeth McLennan, Angus McNair, Kenneth Mealy, Lauren Mecia, Alexander Mehta, Aidan Mellan, Arathi Menon, Donald Menzies, Zhubene Mesbah, David Messenger, George Miller, Aseem Mishra, Sona Mistry, Tahira Mohamed, Nisha Mohamed Mushaini, Midhun Mohan, Ameerah Mohd Azmilssss, Ajay Mohite, Krishna Moorthy, Jalal Moradzadeh, Richard Morgan, Gabriella Morley, Alice Mortimer, Hannah Mownah, Paul Moxey, Gagira Mudalige, Umarah Muhammad, Samuel Munday, Ben Murphy, Ciaran Murphy, Caoimhe Murray, Hannah Murray, Michael Murray, Mohammed Ibrar Murtaza, Jameel Mushtaq, Ameer Mustafa, Shams Mustafa, Laura Myers, Sam Myers, Adeeb Naasan, Kiran Nadeem, Hanzla Naeem, Prashant Naik, Arun Nair, Keshav K. Nambiar, Muhammad Naqi, Zehra Naqvi, Yan Ning Neo, Georgia Irene Neophytou, Jonathan Neville, Tom Newman, Benjamin Ng, Guat Ng, Jing Qi Ng, Vincent Ng, Zhan Herr Ng, Maire Ni Bhoirne, James Nicholas, Gary Nicholson, George Ninkovic-Hall, Gemma Nixon, Mike Norwood, Toby Noton, Romman Nourzaie, Richard Novell, Donald Nyanhongo, James O'Brien, Rory O'Kane, Stephen O'Neill, Hugh O'Sullivan, Thomas Oakley, Chinomso Ogbuokiri, Oluwafunto Ogunleye, Su Oh, Emezie Okorocha, James Olivier, Rele Ologunde, Sharif Omara, Alice Ormrod, Caroline Osborne, Joanna Osmanska, Raisah Owasil, Sebastian Owczarek, Ezgi Ozcan, Sri Palaniappan, Francesco Palazzo, Abbas Palkhi, Gargi Pandey, James Park, Jennifer Parker, Anna Parry, James Parsonage, Lauren Passby, Bhavi Patel, Bhavik Patel, Chantal Patel, Dinisha Patel, Kirtan Patel, Panna Patel, Pratiksha Patel, Trupesh Patel, Mariasoosai Pathmarajah, Amogh Patil, Pradeep Patil, Yusuf Patrick, Jessica Pearce, Lyndsay Pearce, Colin Peirce, Bryony Peiris, Amy Pendrill, Sreelata Periketi, Michael Perry, George Petrov, Charlotte Phillips, Grace Pike, Ana Catarina Pinho-Gomes, Parhana Polly, Arachchige Ponweera, Yanish Poolovadoo, Raunak Poonawala, Petya Popova, Dimitri Pournaras, Brooke Powell, Praveena Prabakaran, Esha Prakash, Tapani Pratumsuwan, Anusha Prem Kumar, Helen Puddy, Michael Pullinger, Nikita Punjabi, Oliver Charles Putt, Omar Qadir, Mubasher Qamar, Patrick Quinn, Arham Qureshi, Mohamed Rabie, Angus Radford, Anand Radhakrishnan, Ansh Radotra, Nasir Rafiq, Aria Rahem, Nahim Rahman, Syed Rahman, Ramesh Rajagopal, Nick Rajan, Nikitha Rajaraman, Sumetha Rajendran, Liandra Ramachenderam, Divya Ramakrishnan, Denisha Ramjas, James Rammell, Ritika Rampal, George Ramsay, Ratan Randhawa, Ellis Rea, Stephanie Rees, Saad Rehman, Salwah Rehman, Nabila Rehnnuma, Melina Rejayee, Zakaria Rob, Charlotte Roberts, Grace Roberts, Ben Roberts, Harry Robinson, Stephen Robinson, Ailin Rogers, Alex Rogers, William Rook, Talisa Ross, Chloe Roy, Azelea Rushd, Duncan Rutherford, Michael Saat, Kaushik Sadanand, Rebecca Sagar, Harkiran Sagoo, Arin Saha, Kapil Sahnan, Mohammed Salik Sait, Saif Sait, Damien Salekin, Mostafa Salem, Nadia Salloum, Emma Sanders, Jasmesh Sandhu, N. Sandhu, Lorna Sandison, Laura Sandland-Taylor, Ron Sangal, Chandan Sanghera, Josephine Saramunda, Lauren Satterthwaite, Moritz Schramm, Rupert Scott, Chloe Searle, Harkiran Seehra, Juan Jose Segura-Sampedro, Harpreet Kaur Sekhon Inderjit Singh, Shaikh Sanjid Seraj, Ishani Seth, Rajiv Sethi, Apar Shah, Mario Shaid, Shafaque Shaikh, Awad Shamali, Elizabeth Sharkey, Abhi Sharma, Neil Sharma, Sachin Sharma, Aniruddh Shenoy, Maleasha Shergill, Shahram Shirazi, Imran Siddiqui, Raykal Sim, Lucy Simmonds, Andrew Simon, William Simpson, Bharpoor Singh, J. Singh, Prashant Singh, Anant Sinha, Sidhartha Sinha, Robert Sinnerton, Chaamanti Sivakumar, Brendan Skelly, Richard Slater, Samuel Small, Neil Smart, Yat Wing Smart, Alexander Smith, Charlotte Smith, Jason Smith, Rebecca Smith, Scott Smith, Peter Sodde, Zhi Min Soh, Aniket Sonsale, Ahmed Soualhi, John Spearman, Robert Spencer, Harry Spiers, Philip Stather, Michael Stoddart, Bradley Storey, Howard Stringer, Thomas Stringfellow, Ben Stubbs, Niv Sukir, Nivian Sukirthan, Yasir Suleman, Aparnah Sureshkumar, Ashwin Suri, Timen Swartbol, Hyder Tahir, E. Tian Tan, Huai Ling Tan, Laura Tan, Alethea Tang, Priyal Taribagil, Yao Zong Tay, Beth Taylor, Zara Taylor, Alexandra Thatcher, Rachel Thavayogan, Michael Thomaa, Daniah Thomas, Jenny Thomas, Paul Thomas, Thomas Pinkney, Chris Thompson, Mag Ting, Ethan Toner, Godwin Tong, Jared Torkington, Molly Traish, Miles Triniman, John Trotter, Kwong Tsang, Sanchit Turaga, Hannah Turley, James Turner, Tomas Urbonas, Alexandra Urquhart, Nimai Vadgama, Aashay Vaidya, Gijs van Boxel, Swati Vara, Massimo Varcada, Rebecca Varley, Dee Varma, Martinique Vella-Baldacchino, Sara Venturini, Naina Verma, Saurabh Verma, Gabrielle Vernet, Mark Vipond, Alex von Roon, Qasim Wadood, Kathryn Waite, Lewis Walker, Nathan Walker, Jonathan C.M. Wan, Liyang Wang, Xue Wang, Alex Ward, Thomas Ward, Nienke Warnaar, Lloyd Warren, Oliver Warren, Sam Waters, Angus Watson, Laura Jayne Watson, Dominic Waugh, Daniel Weinberg, Malcolm West, Carla White, Tim White, Katharine Whitehurst, Robert Whitham, Tharindri Wijekoon, Manuk Wijeyaratne, Richard Wilkin, Alex Wilkins, Adam Williams, Gethin Williams, Luke Williams, Robert Williams, Andrew Williamson, Jacinthe Willson, Andrew Wilson, Holly Wilson, James Wilson, Lizzie Wilson, Megan Wilson, Michael Wilson, Rebekah Wilson, Tim Wilson, Evelina Woin, Esther Wright, Jenny Wright, Nicholas Wroe, Joanne Wylie, Yiwang Xu, Satheesh Yalamarthi, Angela Yan, Narisu Yang, Eda Yardimci, Ibrahim Yasin, Ismael Yasin, Noor Yasin, Joseph Yates, Jih Dar Yau, Tricia Yeoh, Joshua Yip, Cissy Yong, Vasudev Zaver, Tatiana Zhelezniakova, and Adreana Zulkifli

Subjects
Medical education, Manchester Cancer Research Centre, business.industry, ResearchInstitutes_Networks_Beacons/mcrc, MEDLINE, General Medicine, 030230 surgery, Collaborative research, 03 medical and health sciences, 0302 clinical medicine, Foundation Programme, Medicine, Surgery, 030212 general & internal medicine, business
Published
2017
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4. Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy: the role of myocardial replacement fibrosis and the microcirculation

Author

Vassilis Vassiliou, Peter D. Gatehouse, Alphonsus C. Liew, Li-Yueh Hsu, Ruth Owen, David N. Firmin, Gajen Kanaganayagam, Sanjay K Prasad, Miguel Silva Vieira, Tevfik F Ismail, Claire E. Raphael, Andrew E. Arai, Frances M. Mitchell, Kristi Sun, Michael P. Frenneaux, Elisa Di Pietro, John Gregson, Simon Newsome, Robert Cooper, Aamir Ali Mrcp, Lina Kanapeckaite, Dudley J. Pennell, Brandon Wong, Rory O'Hanlon, Stuart A. Cook, and British Heart Foundation

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Time Factors, Cardiac & Cardiovascular Systems, 030204 cardiovascular system & hematology, Ventricular tachycardia, Ventricular Function, Left, 030218 nuclear medicine & medical imaging, RC1200, 0302 clinical medicine, Risk Factors, Myocardial perfusion, Registries, 1102 Cardiorespiratory Medicine and Haematology, Body surface area, education.field_of_study, Ejection fraction, Radiological and Ultrasound Technology, Radiology, Nuclear Medicine & Medical Imaging, Hypertrophic cardiomyopathy, Myocardial Perfusion Imaging, Middle Aged, Prognosis, Magnetic Resonance Imaging, Nuclear Medicine & Medical Imaging, Microvascular ischemia, Cardiology, Disease Progression, cardiovascular system, Female, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Population, Heart failure, Risk Assessment, perfusion, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Coronary Circulation, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, education, Angiology, Aged, Retrospective Studies, Science & Technology, business.industry, Research, Microcirculation, Myocardium, Stroke Volume, Cardiomyopathy, Hypertrophic, medicine.disease, Myocardial&#160, Fibrosis, R1, Transplantation, lcsh:RC666-701, Cardiovascular System & Cardiology, Cardiovascular magnetic resonance, business
Abstract

Introduction Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational cohort study. Methods Serial patients with HCM underwent CMR, including adenosine first-pass perfusion, left atrial (LA) and left ventricular (LV) volumes indexed to body surface area (i) and late gadolinium enhancement (%LGE- as a % of total myocardial mass). We used a composite endpoint of HF death, cardiac transplantation, and progression to NYHA class III/IV. Results A total of 543 patients with HCM underwent CMR, of whom 94 met the composite endpoint at baseline. The remaining 449 patients were followed for a median of 5.6 years. Thirty nine patients (8.7%) reached the composite endpoint of HF death (n = 7), cardiac transplantation (n = 2) and progression to NYHA class III/IV (n = 20). The annual incidence of HF was 2.0 per 100 person-years, 95% CI (1.6–2.6). Age, previous non-sustained ventricular tachycardia, LV end-systolic volume indexed to body surface area (LVESVI), LA volume index ; LV ejection fraction, %LGE and presence of mitral regurgitation were significant univariable predictors of HF, with LVESVI (Hazard ratio (HR) 1.44, 95% confidence interval (95% CI) 1.16–1.78, p = 0.001), %LGE per 10% (HR 1.44, 95%CI 1.14–1.82, p = 0.002) age (HR 1.37, 95% CI 1.06–1.77, p = 0.02) and mitral regurgitation (HR 2.6, p = 0.02) remaining independently predictive on multivariable analysis. The presence or extent of inducible perfusion defect assessed using a visual score did not predict outcome (p = 0.16, p = 0.27 respectively). Discussion The annual incidence of HF in a contemporary ambulatory HCM population undergoing CMR is low. Myocardial fibrosis and LVESVI are strongly predictive of future HF, however CMR visual assessment of myocardial perfusion was not.

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