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Raphael, Claire E., Mitchell, Frances M., Kanaganayagam, Gajen Sunthar, Liew, Alphonsus C., Di Pietro, Elisa, Vieira, Miguel Silva, Kanapeckaite, Lina, Newsome, Simon J., Gregson, John, Owen, Ruth, Hsu, Li Yueh, Vassiliou, Vassilios 
ORCID: https://orcid.org/0000-0002-4005-7752, Cooper, Robert, Ali, Aamir, Ismail, Tevfik F., Wong, Brandon, Sun, Kristi, Gatehouse, Peter D., Firmin, David, Cook, Stuart A., Frenneaux, Michael, Arai, Andrew, O’Hanlon, Rory, Pennell, Dudley J. and Prasad, Sanjay K.
(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.
ISSN 1097-6647
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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 |
|---|---|
| Uncontrolled Keywords: | cardiovascular magnetic resonance,fibrosis,heart failure,hypertrophic cardiomyopathy,microvascular ischemia,myocardial perfusion,prognosis,radiological and ultrasound technology,radiology nuclear medicine and imaging,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/3600/3614 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 03 Feb 2021 00:59 |
| Last Modified: | 07 Dec 2024 01:32 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/79144 |
| DOI: | 10.1186/s12968-021-00720-9 |
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