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Prognostic Role of the Progression of Late Gadolinium Enhancement in Hypertrophic Cardiomyopathy.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2024 Jan 15; Vol. 211, pp. 199-208. Date of Electronic Publication: 2023 Nov 08. - Publication Year :
- 2024
-
Abstract
- In hypertrophic cardiomyopathy (HCM), late gadolinium enhancement (LGE) extent ≥15% of left ventricular mass is considered a prognostic risk factor. LGE extent increases over time and the clinical role of the progression of LGE over time (LGE rate) was not prospectively evaluated. We sought to evaluate the prognostic role of the LGE rate in HCM. We enrolled 105 patients with HCM who underwent cardiac magnetic resonance (CMR) at baseline (CMR-I) and after ≥2 years of follow-up (CMR-II). LGE rate was defined as the ratio between the increase of LGE extent (grams) and the time interval (months) between examinations. A combined end point of sudden cardiac death, resuscitated cardiac arrest, appropriate Implanted Cardioverter Defibrillator (ICD) intervention, and sustained ventricular tachycardia was used (hard events). The percentage of patients with LGE extent ≥15% increased from 9% to 20% from CMR-I to CMR-II (p = 0.03). During a median follow-up of 52 months, 25 hard events were recorded. The presence of LGE ≥15% at CMR-II allowed a significant reclassification of the risk of patients than at LGE ≥15% at CMR-I (net reclassification improvement 0.21, p = 0.046). On the MaxStat analysis, the optimal prognostic cut point for LGE rate was >0.07 g/month. On the Kaplan-Meier curve, patients with LGE rate >0.07 had worse prognosis than those without (p <0.0001). LGE rate >0.07 allowed a significant reclassification of the risk compared with LGE ≥15% at CMR-I and at CMR-II (net reclassification improvement 0.49, p = 0.003). In the multivariable models, LGE rate >0.07 was the best independent predictor of hard events. In conclusion, CMR should be repeated after 2 years to reclassify the risk for sudden death of those patients. A high LGE rate may be considered a novel prognostic factor in HCM.<br />Competing Interests: Declaration of Competing Interest The authors have no competing interest to declare.<br /> (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Prognosis
Gadolinium pharmacology
Heart
Risk Factors
Death, Sudden, Cardiac epidemiology
Death, Sudden, Cardiac etiology
Death, Sudden, Cardiac prevention & control
Magnetic Resonance Imaging, Cine
Predictive Value of Tests
Contrast Media pharmacology
Cardiomyopathy, Hypertrophic diagnostic imaging
Cardiomyopathy, Hypertrophic pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 211
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 37949342
- Full Text :
- https://doi.org/10.1016/j.amjcard.2023.11.003