Highlights
- •The global ECV is better than LGE, global native T1, and global postcontrast T1 in predicting the risk of SCD in HCM patients.
- •The global ECV is comparable to the HCM Risk-SCD scale in predicting SCD risk.
- •Cox regression analysis also showed that global ECV is an independent predictor of SCD adverse events in patients with HCM.
Rationale and Objectives
The aim of the study was to determine whether myocardial fibrosis parameters of cardiac
magnetic resonance imaging (MRI) has added value in the risk stratification of hypertrophic
cardiomyopathy (HCM) patients.
Materials and Methods
In this retrospective study, 108 patients with HCM (mean age ± standard deviation,
55.5 ± 13.4 years) were included from January 2019 to April 2022, and were followed
up for 2 years to record sudden cardiac death (SCD) adverse events. All HCM patients
underwent cardiac MRI and were divided into a training cohort (n = 81; mean age, 56.1 ± 13.0 years) and a validation cohort (n = 27; mean age, 57.8 ± 13.9 years). According to the presence of SCD risk factors
defined by the 2020 AHA/ACC guidelines, HCM patients were classified into low-risk
and high-risk groups. Cardiac MRI features, including late gadolinium enhancement
(LGE), T1 mapping, and extracellular volume fraction (ECV), were assessed and compared
between the two groups. Logistic regression analysis was used to select the optimal
predictors of SCD from cardiac MRI features and HCM Risk-SCD score to construct prediction
models. Receiver operating curve (ROC) analysis was used to assess the predictive
performance of the constructed prediction model. Cox regression analysis was also
used to determine the optimal predictors of SCD adverse events.
Results
Multivariate logistic analysis showed that the global ECV was the single myocardial
fibrosis parameter predictive of the risk of SCD (p < 0.001). The areas under the ROC curves (AUC) of global ECV were higher than those
of LGE, global native T1, global postcontrast T1, and HCM Risk-SCD (AUC = 0.85 vs.
0.74, 0.77, 0.63, 0.78). An integrative risk stratification model combining global
ECV (odds ratio, 1.36 [95% CI: 1.16–1.60]; p < 0.001) and HCM Risk-SCD score (odds ratio, 1.63 [95% CI: 1.08–2.47]; p < 0.001) achieved an AUC of 0.89 (95% CI: 0.81-0.96) in the training cohort, which
was significantly higher than that of HCM Risk-SCD score alone (p = 0.03). The AUC of the integrative model was 0.93 (95% CI: 0.84–1.00) in the validation
cohort. Multivariate Cox regression analysis also showed that the global ECV was an
independent predictor of SCD adverse events (hazard ratio, 1.27 [95% CI: 1.10–1.47]).
Conclusion
The ECV derived from cardiac MRI is comparable to the HCM Risk-SCD scale in predicting
the SCD risk stratification in patients with HCM.
Key words
Abbreviations:
HCM (Hypertrophic cardiomyopathy), SCD (Sudden cardiac death), ICD (Implantable cardioverter-defibrillator), LGE (Late gadolinium enhancement), ECV (Extracellular volume fraction), LVOT (Left ventricular outflow tract), VT (ventricular arrhythmia), NSVT (nonsustained ventricular tachycardia), EF (ejection fraction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 03, 2023
Accepted:
December 16,
2022
Received in revised form:
December 11,
2022
Received:
October 7,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
