PMID- 19850699
OWN - NLM
STAT- MEDLINE
DCOM- 20100216
LR  - 20220330
IS  - 1941-3297 (Electronic)
IS  - 1941-3289 (Linking)
VI  - 3
IP  - 1
DP  - 2010 Jan
TI  - Characteristics and clinical significance of late gadolinium enhancement by 
      contrast-enhanced magnetic resonance imaging in patients with hypertrophic 
      cardiomyopathy.
PG  - 51-8
LID - 10.1161/CIRCHEARTFAILURE.109.854026 [doi]
AB  - BACKGROUND: Myocardial late gadolinium enhancement (LGE) on contrast-enhanced 
      magnetic resonance imaging (CE-MRI) of patients with hypertrophic cardiomyopathy 
      (HCM) has been suggested to represent intramyocardial fibrosis and, as such, an 
      adverse prognostic risk factor. We evaluated the characteristics of LGE on CE-MRI 
      and explored whether LGE among patients with HCM was associated with genetic 
      testing, severe symptoms, ventricular arrhythmias, or sudden cardiac death (SCD). 
      METHODS AND RESULTS: Four hundred twenty-four patients with HCM (age=55+/-16 
      years [range 2 to 90], 41% females), without a history of septal 
      ablation/myectomy, underwent CE-MRI (GE 1.5 Tesla). We evaluated the relation 
      between LGE and HCM genes status, severity of symptoms, and the degree of 
      ventricular ectopy on Holter ECG. Subsequent SCD and appropriate implanted 
      cardioverter defibrillator (ICD) therapies were recorded during a mean follow-up 
      of 43+/-14 months (range 16 to 94). Two hundred thirty-nine patients (56%) had 
      LGE on CE-MRI, ranging from 0.4% to 65% of the left ventricle. Gene-positive 
      patients were more likely to have LGE (P<0.001). The frequencies of New York 
      Heart Association class >or=3 dyspnea and angina class >or=3 were similar in 
      patients with and without LGE (125 of 239 [52%] versus 94 of 185 [51%] and 24 of 
      239 [10%] versus 18 of 185 [10%], respectively, P=NS). LGE-positive patients were 
      more likely to have episodes of nonsustained ventricular tachycardia (34 of 126 
      [27%] versus 8 of 94 [8.5%], P<0.001), had more episodes of nonsustained 
      ventricular tachycardia per patient (4.5+/-12 versus 1.1+/-0.3, P=0.04), and had 
      higher frequency of ventricular extrasystoles/24 hours (700+/-2080 versus 
      103+/-460, P=0.003). During follow-up, SCD occurred in 4 patients, and additional 
      4 patients received appropriate ICD discharges. All 8 patients were LGE positive 
      (event rate of 0.94%/y, P=0.01 versus LGE negative). Two additional heart 
      failure-related deaths were recorded among LGE-positive patients. Univariate 
      associates of SCD or appropriate ICD discharge were positive LGE (P=0.002) and 
      presence of nonsustained ventricular tachycardia (P=0.04). The association of LGE 
      with events remained significant after controlling for other risk factors. 
      CONCLUSIONS: In patients with HCM, presence of LGE on CE-MRI was common and more 
      prevalent among gene-positive patients. LGE was not associated with severe 
      symptoms. However, LGE was strongly associated with surrogates of arrhythmia and 
      remained a significant associate of subsequent SCD and/or ICD discharge after 
      controlling for other variables. If replicated, LGE may be considered an 
      important risk factor for sudden death in patients with HCM.
FAU - Rubinshtein, Ronen
AU  - Rubinshtein R
AD  - Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo 
      Clinic, Rochester, MN 55905, USA.
FAU - Glockner, James F
AU  - Glockner JF
FAU - Ommen, Steve R
AU  - Ommen SR
FAU - Araoz, Philip A
AU  - Araoz PA
FAU - Ackerman, Michael J
AU  - Ackerman MJ
FAU - Sorajja, Paul
AU  - Sorajja P
FAU - Bos, J Martijn
AU  - Bos JM
FAU - Tajik, A Jamil
AU  - Tajik AJ
FAU - Valeti, Uma S
AU  - Valeti US
FAU - Nishimura, Rick A
AU  - Nishimura RA
FAU - Gersh, Bernard J
AU  - Gersh BJ
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20091022
PL  - United States
TA  - Circ Heart Fail
JT  - Circulation. Heart failure
JID - 101479941
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiomyopathy, Hypertrophic/complications/*diagnosis
MH  - Child
MH  - Child, Preschool
MH  - *Contrast Media
MH  - Death, Sudden, Cardiac/*etiology
MH  - Female
MH  - *Gadolinium
MH  - Humans
MH  - Image Enhancement/instrumentation/methods
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Risk Factors
EDAT- 2009/10/24 06:00
MHDA- 2010/02/17 06:00
CRDT- 2009/10/24 06:00
PHST- 2009/10/24 06:00 [entrez]
PHST- 2009/10/24 06:00 [pubmed]
PHST- 2010/02/17 06:00 [medline]
AID - CIRCHEARTFAILURE.109.854026 [pii]
AID - 10.1161/CIRCHEARTFAILURE.109.854026 [doi]
PST - ppublish
SO  - Circ Heart Fail. 2010 Jan;3(1):51-8. doi: 10.1161/CIRCHEARTFAILURE.109.854026. 
      Epub 2009 Oct 22.