PMID- 24966307 OWN - NLM STAT- MEDLINE DCOM- 20150115 LR - 20220129 IS - 1468-201X (Electronic) IS - 1355-6037 (Linking) VI - 100 IP - 23 DP - 2014 Dec TI - Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratification of hypertrophic cardiomyopathy. PG - 1851-8 LID - 10.1136/heartjnl-2013-305471 [doi] AB - OBJECTIVE: Myocardial fibrosis identified by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM) is associated with adverse cardiovascular events, but its value as an independent risk factor for sudden cardiac death (SCD) is unknown. We investigated the role of LGE-CMR in the risk stratification of HCM. METHODS: We conducted a prospective cohort study in a tertiary referral centre. Consecutive patients with HCM (n=711, median age 56.3 years, IQR 46.7-66.6; 70.0% male) underwent LGE-CMR and were followed for a median 3.5 years. The primary end point was SCD or aborted SCD. RESULTS: Overall, 471 patients (66.2%) had myocardial fibrosis (median 5.9% of left ventricular mass, IQR: 2.2-13.3). Twenty-two (3.1%) reached the primary end point. The extent but not the presence of fibrosis was a significant univariable predictor of the primary end point (HR per 5% LGE: 1.24, 95% CI 1.06 to 1.45; p=0.007 and HR for LGE: 2.69, 95% CI 0.91 to 7.97; p=0.073, respectively). However, on multivariable analysis, only LV-EF remained statistically significant (HR: 0.92, 95% CI 0.89 to 0.95; p<0.001). For the secondary outcome of cardiovascular mortality/aborted SCD, the presence and the amount of fibrosis were significant predictors on univariable but not multivariable analysis after adjusting for LV-EF and non-sustained ventricular tachycardia. CONCLUSIONS: The amount of myocardial fibrosis was a strong univariable predictor of SCD risk. However, this effect was not maintained after adjusting for LV-EF. Further work is required to elucidate the interrelationship between fibrosis and traditional predictors of outcome in HCM. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. FAU - Ismail, Tevfik F AU - Ismail TF AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Jabbour, Andrew AU - Jabbour A AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Gulati, Ankur AU - Gulati A AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK. FAU - Mallorie, Amy AU - Mallorie A AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Raza, Sadaf AU - Raza S AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Cowling, Thomas E AU - Cowling TE AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Das, Bibek AU - Das B AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Khwaja, Jahanzaib AU - Khwaja J AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Alpendurada, Francisco D AU - Alpendurada FD AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK. FAU - Wage, Ricardo AU - Wage R AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK. FAU - Roughton, Michael AU - Roughton M AD - R-Squared Statistics, London, UK. FAU - McKenna, William J AU - McKenna WJ AD - Institute of Cardiovascular Science, University College London, London, UK. FAU - Moon, James C AU - Moon JC AD - Institute of Cardiovascular Science, University College London, London, UK. FAU - Varnava, Amanda AU - Varnava A AD - West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK. FAU - Shakespeare, Carl AU - Shakespeare C AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Department of Cardiology, South London Healthcare NHS Trust, London, UK. FAU - Cowie, Martin R AU - Cowie MR AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Cook, Stuart A AU - Cook SA AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Elliott, Perry AU - Elliott P AD - Institute of Cardiovascular Science, University College London, London, UK. FAU - O'Hanlon, Rory AU - O'Hanlon R AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK. FAU - Pennell, Dudley J AU - Pennell DJ AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. FAU - Prasad, Sanjay K AU - Prasad SK AD - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK Imperial College London, London, UK. LA - eng GR - MC_U120085815/MRC_/Medical Research Council/United Kingdom GR - BHF_/British Heart Foundation/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140624 PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 1BJ477IO2L (gadobutrol) RN - K2I13DR72L (Gadolinium DTPA) SB - IM CIN - Heart. 2014 Dec;100(23):1821-2. PMID: 25073886 CIN - Heart. 2014 Dec;100(23):1898. PMID: 25248754 MH - Aged MH - Cardiomyopathy, Hypertrophic/complications/*diagnosis/mortality/pathology/therapy MH - Chi-Square Distribution MH - *Contrast Media MH - Death, Sudden, Cardiac/*etiology/pathology/prevention & control MH - Disease-Free Survival MH - Female MH - Fibrosis MH - *Gadolinium DTPA MH - Humans MH - Kaplan-Meier Estimate MH - London MH - *Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Myocardium/*pathology MH - *Organometallic Compounds MH - Predictive Value of Tests MH - Proportional Hazards Models MH - Prospective Studies MH - Risk Assessment MH - Risk Factors MH - Tertiary Care Centers MH - Time Factors EDAT- 2014/06/27 06:00 MHDA- 2015/01/16 06:00 CRDT- 2014/06/27 06:00 PHST- 2014/06/27 06:00 [entrez] PHST- 2014/06/27 06:00 [pubmed] PHST- 2015/01/16 06:00 [medline] AID - heartjnl-2013-305471 [pii] AID - 10.1136/heartjnl-2013-305471 [doi] PST - ppublish SO - Heart. 2014 Dec;100(23):1851-8. doi: 10.1136/heartjnl-2013-305471. Epub 2014 Jun 24.