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Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR



To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT).


A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT.


Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT.


Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators.

Key Points

Global ECV identified the best HCM patients with increased SCD risk.

Global ECV performed equally well compared to a SCD risk score.

Combined use of the SCD risk score and global ECV improved test accuracy.

Combined use potentially improves selection of HCM patients for ICD implantation.

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Fig. 1
Fig. 2



Cardiac magnetic resonance


Extracellular volume


Estimated glomerular filtration rate


Full width half maximum


Hypertrophic cardiomyopathy


Implantable cardioverter defibrillator


Late gadolinium enhancement


Left ventricular


Left ventricular ejection fraction


Left ventricular outflow tract


N-terminal pro b-type natriuretic peptide


New York Heart Association


Modified Look-Locker inversion recovery


Sudden cardiac death


Standard deviation


Troponin T


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Author information

Correspondence to Gunnar Lund.

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The scientific guarantor of this publication is Gunnar K. Lund.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Philips Research, Hamburg, Germany.

Dr. Stehning is an employee of Philips Research, Hamburg, Germany.


The authors state that this work has not received any funding.

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.


• prospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Monica Patten and Gunnar Lund contributed equally to this work.

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Avanesov, M., Münch, J., Weinrich, J. et al. Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR. Eur Radiol 27, 5136–5145 (2017). https://doi.org/10.1007/s00330-017-4869-x

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  • Hypertrophic cardiomyopathy
  • Prognosis
  • Late gadolinium enhancement
  • Extracellular volume
  • Risk assessment