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Raphael, CE, Mitchell, F, Kanaganayagam, GS, Liew, AC, Di Pietro, E, Vieira, MS, Kanapeckaite, L, Newsome, S, Gregson, J, Owen, R, Hsu, LY, Vassiliou, V, Cooper, R, Mrcp, AA, Ismail, TF, Wong, B, Sun, K, Gatehouse, P, Firmin, D, Cook, S , Frenneaux, M, Arai, A, O’Hanlon, R, Pennell, DJ and Prasad, SK (2021) Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy: the role of myocardial replacement fibrosis and the microcirculation. Journal of Cardiovascular Magnetic Resonance, 23 (1). ISSN 1097-6647
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Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy.pdf - Published Version Available under License Creative Commons Attribution. Download (1MB) | Preview |
Abstract
Introduction: Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational cohort study. Methods: Serial patients with HCM underwent CMR, including adenosine first-pass perfusion, left atrial (LA) and left ventricular (LV) volumes indexed to body surface area (i) and late gadolinium enhancement (%LGE- as a % of total myocardial mass). We used a composite endpoint of HF death, cardiac transplantation, and progression to NYHA class III/IV. Results: A total of 543 patients with HCM underwent CMR, of whom 94 met the composite endpoint at baseline. The remaining 449 patients were followed for a median of 5.6 years. Thirty nine patients (8.7%) reached the composite endpoint of HF death (n = 7), cardiac transplantation (n = 2) and progression to NYHA class III/IV (n = 20). The annual incidence of HF was 2.0 per 100 person-years, 95% CI (1.6–2.6). Age, previous non-sustained ventricular tachycardia, LV end-systolic volume indexed to body surface area (LVESVI), LA volume index ; LV ejection fraction, %LGE and presence of mitral regurgitation were significant univariable predictors of HF, with LVESVI (Hazard ratio (HR) 1.44, 95% confidence interval (95% CI) 1.16–1.78, p = 0.001), %LGE per 10% (HR 1.44, 95%CI 1.14–1.82, p = 0.002) age (HR 1.37, 95% CI 1.06–1.77, p = 0.02) and mitral regurgitation (HR 2.6, p = 0.02) remaining independently predictive on multivariable analysis. The presence or extent of inducible perfusion defect assessed using a visual score did not predict outcome (p = 0.16, p = 0.27 respectively). Discussion: The annual incidence of HF in a contemporary ambulatory HCM population undergoing CMR is low. Myocardial fibrosis and LVESVI are strongly predictive of future HF, however CMR visual assessment of myocardial perfusion was not.
| Item Type: | Article |
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| Uncontrolled Keywords: | Myocardium; Microcirculation; Humans; Cardiomyopathy, Hypertrophic; Disease Progression; Fibrosis; Magnetic Resonance Imaging; Stroke Volume; Prognosis; Registries; Risk Assessment; Risk Factors; Retrospective Studies; Predictive Value of Tests; Coronary Circulation; Ventricular Function, Left; Time Factors; Adult; Aged; Middle Aged; Female; Male; Heart Failure; Myocardial Perfusion Imaging; Cardiovascular magnetic resonance; Fibrosis; Heart failure; Hypertrophic cardiomyopathy; Microvascular ischemia; Myocardial perfusion; Prognosis; Adult; Aged; Cardiomyopathy, Hypertrophic; Coronary Circulation; Disease Progression; Female; Fibrosis; Heart Failure; Humans; Magnetic Resonance Imaging; Male; Microcirculation; Middle Aged; Myocardial Perfusion Imaging; Myocardium; Predictive Value of Tests; Prognosis; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Stroke Volume; Time Factors; Ventricular Function, Left; Nuclear Medicine & Medical Imaging; 1102 Cardiorespiratory Medicine and Haematology |
| Subjects: | R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC1200 Sports Medicine |
| Divisions: | Sport & Exercise Sciences |
| Publisher: | Springer Science and Business Media LLC |
| SWORD Depositor: | A Symplectic |
| Date Deposited: | 24 Jun 2022 09:28 |
| Last Modified: | 24 Jun 2022 09:30 |
| DOI or ID number: | 10.1186/s12968-021-00720-9 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/17144 |
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