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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

Abstract

Objectives

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).

Methods

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.

Results

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.

Conclusions

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
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Abbreviations

CMR:

Cardiac magnetic resonance

ECV:

Extracellular volume

eGFR:

Estimated glomerular filtration rate

FWHM:

Full width half maximum

HCM:

Hypertrophic cardiomyopathy

ICD:

Implantable cardioverter defibrillator

LGE:

Late gadolinium enhancement

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

LVOT:

Left ventricular outflow tract

NT-proBNP:

N-terminal pro b-type natriuretic peptide

NYHA:

New York Heart Association

MOLLI:

Modified Look-Locker inversion recovery

SCD:

Sudden cardiac death

SD:

Standard deviation

TNT:

Troponin T

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Author information

Correspondence to Gunnar Lund.

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Guarantor

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.

Funding

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.

Methodology

• 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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Keywords

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