Prognostic Role of Late Gadolinium Enhancement in Patients With Hypertrophic Cardiomyopathy and Low-to-Intermediate Sudden Cardiac Death Risk Score

Giancarlo Todiere, Cinzia Nugara, Giovanni Gentile, Francesco Negri, Francesco Bianco, Calogero Falletta, Giuseppina Novo, Gianluca Di Bella, Raffaele De Caterina, Elisabetta Zachara, Federica Re, Francesco Clemenza, Gianfranco Sinagra, Michele Emdin, Giovanni Donato Aquaro

Research output: Contribution to journalArticle

Abstract

Sudden cardiac death (SCD) is the most life-threating complication of hypertrophic cardiomyopathy. Guidelines of the European Society of Cardiology (ESC) suggest the implantation of an implantable cardioverter defibrillator in primary prevention according to a 5-year risk SCD score ≥6%. The aim of the study is to evaluate the prognostic role of late gadolinium enhancement (LGE) in patients with a 5-year risk SCD score <6%. In this multicenter study, we performed cardiac magnetic resonance in 354 consecutive hypertrophic cardiomyopathy patients (257 males, range of age 54 ± 17) with a risk SCD score <6% (302 with <4% and 52 with ≥4 and <6% risk). Hard cardiac events, including SCD, resuscitated cardiac arrest, appropriate implantable cardioverter defibrillator interventions, sustained ventricular tachycardia, occurred in 22 patients. LGE was detected in a high proportion (92%) of patients with hard cardiac events (p = 0.002). At receiver-operating characteristic curve analysis, LGE extent ≥10% was the best threshold to predict major arrhythmic events (area under the curve: 0.74). Kaplan-Meier curves showed that patients with LGE ≥10% had a worse prognosis than those with lower extent (p < 0.0001). LGE extent was the best independent predictor of hard cardiac events (hazard ratio 1.05; 95% confidence interval [CI] 1.03 to 107; p < 0.0001). The estimates 5-year risk of hard cardiac event was 2.5% (95% CI 0.8 to 4.2) in patients with LGE extent <10% and 23.4% (95% CI 10.2 to 36.5) for those with LGE extent ≥10%. In conclusion, this study demonstrates as the extent of LGE ≥10% is able to recognize additional patients at increased risk for malignant arrhythmic episodes in a population with low-to-intermediate ESC SCD risk score.

Original languageEnglish
Pages (from-to)1286-1292
Number of pages7
JournalAmerican Journal of Cardiology
Volume124
Issue number8
DOIs
Publication statusPublished - Oct 15 2019

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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