PMID- 30115224 OWN - NLM STAT- MEDLINE DCOM- 20190911 LR - 20190911 IS - 1558-3597 (Electronic) IS - 0735-1097 (Linking) VI - 72 IP - 8 DP - 2018 Aug 21 TI - Late Gadolinium Enhancement in Patients With Hypertrophic Cardiomyopathy and Preserved Systolic Function. PG - 857-870 LID - S0735-1097(18)35269-0 [pii] LID - 10.1016/j.jacc.2018.05.060 [doi] AB - BACKGROUND: A high proportion of patients with hypertrophic cardiomyopathy (HCM) have evidence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). OBJECTIVES: This study sought to assess the incremental prognostic utility of LGE in patients with HCM. METHODS: We studied 1,423 consecutive low-/intermediate-risk patients with HCM (age >/=18 years) with preserved left ventricular (LV) ejection fraction (mean age 66 +/- 14 years, 60% men) who underwent transthoracic echocardiography (TTE) (including dimensions and LV outflow tract gradients) and CMR (including LGE as a % of LV mass) at our center between January 2008 and December 2015. The primary composite endpoint was sudden cardiac death (SCD) and appropriate implantable cardioverter-defibrillator discharge. The percent 5-year SCD risk score was calculated. RESULTS: The mean 5-year SCD risk score was 2.3 +/- 2.0. Mean maximal LV outflow tract gradient (TTE) was 70 +/- 55 mm Hg (median 74 mm Hg [interquartile range (IQR): 10 to 67 mm Hg]); indexed LV mass and LGE (both on CMR) were 91 +/- 10 g/m(2) and 8.4 +/- 12% (IQR: 0% to 19%); 50% had LGE on CMR. Of these, 458 were nonobstructive and 965 were obstructive (of which 686 were underwent myectomy). At 4.7 +/- 2.0 years of follow-up, 60 (4%) met the composite endpoint. On quadratic spline analysis, LGE >/=15% was associated with increased risk of composite events. In the obstructive subgroup, on competing risk regression analysis, >/=15% LGE (subhazard ratio: 3.04 [95% confidence interval: 1.48 to 6.10]) was associated with a higher rate and myectomy (subhazard ratio: 0.44 [95% confidence interval: 0.20 to 0.76]) was associated with a lower rate of composite endpoints (both p < 0.01). Similarly, sequential addition of LGE >/=15% and myectomy to % 5-year SCD risk score improved the log likelihood ratios from -227.85 to -219.14 (chi-square 17) and to -215.14 (chi-square 8; both p < 0.01). Association of %LGE with composite events was similar even in myectomy and nonobstructive subgroups. CONCLUSIONS: In low-/intermediate-risk adult patients with HCM (obstructive, myectomy, and nonobstructive subgroups) with preserved systolic function, %LGE was significantly associated with a higher rate of composite endpoint, providing incremental prognostic utility. CI - Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Mentias, Amgad AU - Mentias A AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Raeisi-Giglou, Pejman AU - Raeisi-Giglou P AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Smedira, Nicholas G AU - Smedira NG AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Feng, Ke AU - Feng K AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Sato, Kimi AU - Sato K AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Wazni, Oussama AU - Wazni O AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Kanj, Mohamad AU - Kanj M AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Flamm, Scott D AU - Flamm SD AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Thamilarasan, Maran AU - Thamilarasan M AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Popovic, Zoran B AU - Popovic ZB AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Lever, Harry M AU - Lever HM AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. FAU - Desai, Milind Y AU - Desai MY AD - Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: desaim2@ccf.org. LA - eng PT - Journal Article PT - Observational Study PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 RN - 0 (Contrast Media) RN - AU0V1LM3JT (Gadolinium) SB - IM CIN - J Am Coll Cardiol. 2018 Aug 21;72(8):871-873. PMID: 30115225 EIN - J Am Coll Cardiol. 2018 Oct 2;72(14):1761. PMID: 30170076 CIN - Aging (Albany NY). 2019 Mar 28;11(6):1617-1618. PMID: 30923259 MH - Aged MH - Aged, 80 and over MH - Cardiomyopathy, Hypertrophic/*diagnostic imaging/physiopathology MH - Contrast Media MH - Echocardiography/*methods MH - Female MH - Follow-Up Studies MH - Gadolinium/*administration & dosage MH - Humans MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Retrospective Studies MH - Stroke Volume/*physiology MH - Systole/*physiology OTO - NOTNLM OT - cardiac magnetic resonance OT - hypertrophic cardiomyopathy OT - risk stratification EDAT- 2018/08/18 06:00 MHDA- 2019/09/12 06:00 CRDT- 2018/08/18 06:00 PHST- 2018/03/26 00:00 [received] PHST- 2018/05/23 00:00 [revised] PHST- 2018/05/23 00:00 [accepted] PHST- 2018/08/18 06:00 [entrez] PHST- 2018/08/18 06:00 [pubmed] PHST- 2019/09/12 06:00 [medline] AID - S0735-1097(18)35269-0 [pii] AID - 10.1016/j.jacc.2018.05.060 [doi] PST - ppublish SO - J Am Coll Cardiol. 2018 Aug 21;72(8):857-870. doi: 10.1016/j.jacc.2018.05.060.