Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy: the role of myocardial replacement fibrosis and the microcirculation

Journal of Cardiovascular Magnetic Resonance

Li-Yueh Hsu¹  Andrew Arai¹  Rory O’Hanlon²  Elisa Di Pietro³  Tevfik F. Ismail⁴  Simon Newsome⁵  John Gregson⁵  Ruth Owen⁵  Robert Cooper⁶  Sanjay K. Prasad⁶  Miguel Silva Vieira⁶  Vassilis Vassiliou⁶  Aamir Ali MRCP⁶  Claire E. Raphael⁶  Stuart Cook⁶  Kristi Sun⁶  David Firmin⁶  Brandon Wong⁶  Gajen Sunthar Kanaganayagam⁶  Frances Mitchell⁶  Dudley J. Pennell⁶  Alphonsus C. Liew⁶  Lina Kanapeckaite⁶  Peter Gatehouse⁶  Michael Frenneaux⁷ 

[1] Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health;Blackrock Clinic;Department of Advanced Biomedical Sciences, University of Naples;King’s College London & Guy’s and St Thomas’ NHS Foundation Trust;London School of Hygiene & Tropical Medicine;NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital;Norwich Medical School, University of East Anglia;

关键词: Hypertrophic cardiomyopathy;    Heart failure;    Prognosis;    Cardiovascular magnetic resonance;    Fibrosis;    Microvascular ischemia;   

DOI  :  10.1186/s12968-021-00720-9

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown