PMID- 31412875
OWN - NLM
STAT- MEDLINE
DCOM- 20200504
LR  - 20240117
IS  - 1532-429X (Electronic)
IS  - 1097-6647 (Print)
IS  - 1097-6647 (Linking)
VI  - 21
IP  - 1
DP  - 2019 Aug 15
TI  - The amount of late gadolinium enhancement outperforms current 
      guideline-recommended criteria in the identification of patients with 
      hypertrophic cardiomyopathy at risk of sudden cardiac death.
PG  - 50
LID - 10.1186/s12968-019-0561-4 [doi]
LID - 50
AB  - BACKGROUND: Identifying the patients with hypertrophic cardiomyopathy (HCM) in 
      whom the risk of sudden cardiac death (SCD) justifies the implantation of a 
      cardioverter-defibrillator (ICD) in primary prevention remains challenging. 
      Different risk stratification and criteria are used by the European and American 
      guidelines in this setting. We sought to evaluate the role of cardiovascular 
      magnetic resonance (CMR) late gadolinium enhancement (LGE) in improving these 
      risk stratification strategies. METHODS: We conducted a multicentric 
      retrospective analysis of HCM patients who underwent CMR for diagnostic 
      confirmation and/or risk stratification. Eligibility for ICD was assessed 
      according to the HCM Risk-SCD score and the American College of Cardiology 
      Foundation/American Heart Association (ACCF/AHA) algorithm. The amount of LGE was 
      quantified (LGE%) and categorized as 0%, 0.1-10%, 10.1-19.9% and >/= 20%. The 
      primary endpoint was a composite of SCD, aborted SCD, sustained ventricular 
      tachycardia (VT), or appropriate ICD discharge. RESULTS: A total of 493 patients 
      were available for analysis (58% male, median age 46 years). LGE was present in 
      79% of patients, with a median LGE% of 2.9% (IQR 0.4-8.4%). The concordance 
      between risk assessment by the HCM Risk-SCD, ACCF/AHA and LGE was relatively 
      weak. During a median follow-up of 3.4 years (IQR 1.5-6.8 years), 23 patients 
      experienced an event (12 SCDs, 6 appropriate ICD discharges and 5 sustained VTs). 
      The amount of LGE was the only independent predictor of outcome (adjusted HR: 
      1.08; 95% CI: 1.04-1.12; p <  0.001) after adjustment for the HCM Risk-SCD and 
      ACCF/AHA criteria. The amount of LGE showed greater discriminative power 
      (C-statistic 0.84; 95% CI: 0.76-0.91) than the ACCF/AHA (C-statistic 0.61; 95% 
      CI: 0.49-0.72; p for comparison < 0.001) and the HCM Risk-SCD (C-statistic 0.68; 
      95% CI: 0.59-0.78; p for comparison = 0.006). LGE was able to increase the 
      discriminative power of the ACCF/AHA and HCM Risk-SCD criteria, with net 
      reclassification improvements of 0.36 (p = 0.021) and 0.43 (p = 0.011), 
      respectively. CONCLUSIONS: The amount of LGE seems to outperform the HCM Risk-SCD 
      score and the ACCF/AHA algorithm in the identification of HCM patients at 
      increased risk of SCD and reclassifies a relevant proportion of patients.
FAU - Freitas, Pedro
AU  - Freitas P
AUID- ORCID: 0000-0001-9968-477X
AD  - Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute 
      (InCor), University of Sao Paulo Medical School, Avenida Dr. Eneas de Carvalho 
      Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil.
AD  - Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa 
      Ocidental, EPE, Lisbon, Portugal.
FAU - Ferreira, Antonio Miguel
AU  - Ferreira AM
AD  - Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa 
      Ocidental, EPE, Lisbon, Portugal.
AD  - Advanced Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal.
FAU - Arteaga-Fernandez, Edmundo
AU  - Arteaga-Fernandez E
AD  - Laboratory of Genetics and Molecular Cardiology and Cardiomyopathies Unit, Heart 
      Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
FAU - de Oliveira Antunes, Murrilo
AU  - de Oliveira Antunes M
AD  - Laboratory of Genetics and Molecular Cardiology and Cardiomyopathies Unit, Heart 
      Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
FAU - Mesquita, Joao
AU  - Mesquita J
AD  - Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa 
      Ocidental, EPE, Lisbon, Portugal.
FAU - Abecasis, Joao
AU  - Abecasis J
AD  - Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa 
      Ocidental, EPE, Lisbon, Portugal.
AD  - Cardiovascular Department, Hospital dos Lusiadas, Lisbon, Portugal.
FAU - Marques, Hugo
AU  - Marques H
AD  - Advanced Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal.
FAU - Saraiva, Carla
AU  - Saraiva C
AD  - Radiology Department, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, 
      Portugal.
FAU - Matos, Daniel Nascimento
AU  - Matos DN
AD  - Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa 
      Ocidental, EPE, Lisbon, Portugal.
FAU - Rodrigues, Rita
AU  - Rodrigues R
AD  - Advanced Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal.
FAU - Cardim, Nuno
AU  - Cardim N
AD  - Advanced Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal.
FAU - Mady, Charles
AU  - Mady C
AD  - Laboratory of Genetics and Molecular Cardiology and Cardiomyopathies Unit, Heart 
      Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
FAU - Rochitte, Carlos Eduardo
AU  - Rochitte CE
AD  - Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute 
      (InCor), University of Sao Paulo Medical School, Avenida Dr. Eneas de Carvalho 
      Aguiar, 44, Andar AB, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil. 
      rochitte@incor.usp.br.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20190815
PL  - England
TA  - J Cardiovasc Magn Reson
JT  - Journal of cardiovascular magnetic resonance : official journal of the Society 
      for Cardiovascular Magnetic Resonance
JID - 9815616
RN  - 0 (Contrast Media)
SB  - IM
MH  - Adult
MH  - Brazil
MH  - Cardiomyopathy, Hypertrophic/complications/*diagnostic imaging/therapy
MH  - Clinical Decision-Making
MH  - Contrast Media/*administration & dosage
MH  - Death, Sudden, Cardiac/*etiology/prevention & control
MH  - Defibrillators, Implantable
MH  - Electric Countershock/instrumentation
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging/*standards
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Portugal
MH  - Practice Guidelines as Topic/*standards
MH  - Predictive Value of Tests
MH  - Primary Prevention
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
PMC - PMC6694533
OTO - NOTNLM
OT  - Hypertrophic cardiomyopathy
OT  - Risk stratification
COIS- The authors declare that they have no competing interests.
EDAT- 2019/08/16 06:00
MHDA- 2020/05/06 06:00
PMCR- 2019/08/15
CRDT- 2019/08/16 06:00
PHST- 2019/01/16 00:00 [received]
PHST- 2019/07/01 00:00 [accepted]
PHST- 2019/08/16 06:00 [entrez]
PHST- 2019/08/16 06:00 [pubmed]
PHST- 2020/05/06 06:00 [medline]
PHST- 2019/08/15 00:00 [pmc-release]
AID - S1097-6647(23)00223-5 [pii]
AID - 561 [pii]
AID - 10.1186/s12968-019-0561-4 [doi]
PST - epublish
SO  - J Cardiovasc Magn Reson. 2019 Aug 15;21(1):50. doi: 10.1186/s12968-019-0561-4.