Cardiac magnetic resonance imaging and sudden death risk in patients with hypertrophic cardiomyopathy.

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Predicting the future is always hard, and no more so than in a common disease like hypertrophic cardiomyopathy (HCM), which is usually associated with few if any symptoms yet can be a rare cause of sudden death in young people. For decades, the approach to the identification of individuals at high risk has been based on a semiquantitative estimation of relative risk derived from the summation of a small number of clinical markers. There are no prospective data on which to judge the clinical efficacy of this approach, but retrospective analyses suggest that it is only modestly predictive of future events.1 Similar dilemmas in other areas of medicine have been addressed with sophisticated risk models designed to estimate absolute risks. Until recently, the approach in HCM has been very different. Most investigators have hunted for new and ever more sophisticated tools that provide a window into the complex substrate that causes ventricular arrhythmia. In this issue of Circulation , Chan et al2 present a study using cardiac magnetic resonance imaging (CMR) and suggest that it improves on current risk prediction methods. Specifically, they suggest that CMR assessment of late gadolinium enhancement (LGE) provides the following: a statistically stronger predictor of sudden cardiac death events than each of the individual conventional risk factors used in HCM; a “unique opportunity” to identify sudden cardiac death risk in asymptomatic HCM patients, previously thought to be at low risk for lethal ventricular tachyarrhythmias; and the ability to identify unrecognized high-risk patients who could potentially benefit from implantable cardioverter-defibrillator (ICD) therapy. Given the high stakes associated with …