Abstract
Extent of late gadolinium enhancement (LGE) quantified by cardiac magnetic resonance was reportedly helpful for predicting the risk of ventricular tachyarrhythmias (VTA) in hypertrophic cardiomyopathy (HCM) patients. However, only a few data exist on the clinical implication of semi-quantitative assessment LGE extent in this patient population. The extent of left ventricular (LV) LGE was measured in 310 consecutive HCM patients using semi-quantitative (summing the LV segments with LGE, spatial extent) and quantitative (calculating the LGE volume percentage [vol% of LGE] against the total LV myocardial volume) methods, respectively. LV LGE was detected in 255 (82%) patients, most frequently in the mid-LV septum (n = 160, 52%). During the 49 ± 45 month follow-up, spontaneous VTA events were observed in 48 patients (16%) including aborted sudden cardiac death (SCD), appropriate defibrillator shock, and non-sustained VTA. The extent of LGE assessed by the two different methods showed a strong positive correlation (Spearman’s r = 0.63, P < 0.001). Moreover, there was a graded increase in the rates of VTA with the LGE extent evaluated semi-quantitatively and quantitatively. The extent of LGE was identified as an independent predictor of VTA events and more extensive LGE (positive ≥ 4 segments) significantly raised the risk of VTA, irrespective of the presence of conventional risk factors for SCD including family history, unexplained syncope, LV wall thickness ≥30 mm. The extent of LGE, whether assessed by semi-quantitative or quantitative methods, was closely associated with an increased risk of spontaneous VTA events in HCM patients.
Highlights
Extent of late gadolinium enhancement (LGE) quantified by cardiac magnetic resonance was reportedly helpful for predicting the risk of ventricular tachyarrhythmias (VTA) in hypertrophic cardiomyopathy (HCM) patients
Late gadolinium enhancement (LGE) detected by cardiac magnetic resonance (CMR) imaging has been established as a useful method for in vivo detection of myocardial scarring in patients with ischemic and non-ischemic cardiomyopathies[1,2,3]
In the present study, we evaluated the risks of VTA/sudden cardiac death (SCD) according to the extent of LGE assessed using two different methods; quantitative and semi-quantitative
Summary
We excluded patients with (a) uncontrolled hypertension (systolic ≥160 or diastolic blood pressure ≥100 mm Hg despite use of antihypertensive drugs), (b) moderate or severe aortic valve stenoinsufficiency, (c) myocardial infiltrative or storage disease, (d) history of septal myectomy or alcohol ablation, (e) CMR study performed without LGE protocol, or (f) inadequate image quality for assessing the presence of LGE. After finishing the semi-quantitative visual assessment, the LV LGE volume was quantified as a percentage of the total LV myocardial volume (vol%), which was computed by summing the percent area of LGE in each short-axis scan image, multiplied by the slice thickness along the entire LV. Correlations (1) between the extents of LGE measured by two different methods, and (2) between the (quantitative and semi-quantitative) LGE extent and the rate of VTA were assessed by the Spearman rank correlation coefficient, respectively. The present study was carried out in accordance with the ethical principles of the Declaration of Helsinki and the requirement for written informed consent was waived
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