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Late gadolinium enhancement (LGE) using cardiac magnetic resonance has emerged as the gold-standard technique for imaging of myocardial fibrosis which associated with the incidence of ventricular tachyarrhythmia and may convey prognostic importance in hypertrophic cardiomyopathy (HCM). Intermediate LGE signal-intensity (LGE-SI) is reported to be a better predictor of ventricular tachyarrhythmia than high LGE-SI, although long-term evaluation is absent. This study is aimed to assess the relationship between these LGE-SI and development of major adverse cardiovascular events (MACE) including ventricular tachyarrhythmia.
In 106 HCM patients (69 males, mean age 56±18 years), the area of LGE was quantitatively analyzed to determine the intermediate (>2 and <6SD) and high SI (>6SD above the mean SI of normal myocardium). The extent of LGE was expressed as a percentage of the total left ventricular mass. We examined which condition of LGE-SI predicts the incidence of ventricular tachyarrhythmia and/or MACE more precisely in the patients with HCM.
Not intermediate but high LGE-SI was associated with sustained and nonsustained ventricular tachycardia at the baseline (P<0.05, respectively). During the mean follow-up period of 1075±515 days, 27 (25%) patients developed MACE of either unplanned heart failure hospitalization (n=22), ventricular fibrillation (n=1), stroke due to cardiac emboli (n=2) or appropriate implantable cardioverter defibrillator discharge (n=2). Among them, 4 patients died of heart failure, 5 underwent implantation of left ventricular assist device and 1 underwent heart transplantation. The high LGE-SI was an independent predictors of overall MACE (odds ratio=1.06, 95% confidence interval=1.01 to 1.12, p=0.018), although neither intermediate nor high LGE-SI was a predictor of ventricular tachyarrhythmia.
High LGE-SI is a better predictor of overall MACE including ventricular tachyarrhythmia than intermediate LGE-SI, although both intermediate and high LGE-SI were not useful for predicting ventricular arrhythmia.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Hypertrophic Cardiomyopathy: MRI-Based Phenotyping
Abstract Category: 23. Pericardial/Myocardial Disease
Presentation Number: 1121M-143
- 2013 American College of Cardiology Foundation