Prognostic Significance of Myocardial Fibrosis in Hypertrophic Cardiomyopathy

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:56

Article

O'Hanlon, Rory¹  Grasso, Agata¹  Moon, James C.⁴  Clark, Susan¹  Wage, Ricardo¹  Webb, Jessica¹  Kulkarni, Meghana¹  Dawson, Dana¹  Sulaibeekh, Leena¹  Chandrasekaran, Badri¹  Bucciarelli-Ducci, Chiara¹  Pasquale, Ferdinando⁴  Cowie, Martin R.²  McKenna, William J.⁵  Sheppard, Mary N.³  Elliott, Perry M.⁵  Pennell, Dudley J.¹  Prasad, Sanjay K.¹ 

[1] Royal Brompton & Harefield NHS Fdn Trust, Dept Cardiovasc Magnet Resonance, London, England

[2] Royal Brompton & Harefield NHS Fdn, Dept Cardiovasc Med, London, England

[3] Royal Brompton & Harefield NHS Fdn Trust, Dept Histopathol, London, England

[4] UCL, Dept Cardiovasc Magnet Resonance, London WC1E 6BT, England

[5] UCL, Dept Cardiovasc Med, London WC1E 6BT, England

关键词: cardiovascular magnetic resonance;    hypertrophic cardiomyopathy;    late gadolinium enhancement;    myocardial fibrosis;   

DOI  :  10.1016/j.jacc.2010.05.010

来源: Elsevier

【 摘 要 】

Objectives We investigated the significance of fibrosis detected by late gadolinium enhancement cardiovascular magnetic resonance for the prediction of major clinical events in hypertrophic cardiomyopathy (HCM). Background The role of myocardial fibrosis in the prediction of sudden death and heart failure in HCM is unclear with a lack of prospective data. Methods We assessed the presence and amount of myocardial fibrosis in HCM patients and prospectively followed them for the development of morbidity and mortality in patients over 3.1 +/- 1.7 years. Results Of 217 consecutive HCM patients, 136 (63%) showed fibrosis. Thirty-four of the 136 patients (25%) in the fibrosis group but only 6 of 81 (7.4%) patients without fibrosis reached the combined primary end point of cardiovascular death, unplanned cardiovascular admission, sustained ventricular tachycardia or ventricular fibrillation, or appropriate implantable cardioverter-defibrillator discharge (hazard ratio [HR]: 3.4, p = 0.006). In the fibrosis group, overall risk increased with the extent of fibrosis (HR: 1.18/5% increase, p = 0.008). The risk of unplanned heart failure admissions, deterioration to New York Heart Association functional class III or IV, or heart failure-related death was greater in the fibrosis group (HR: 2.5, p = 0.021), and this risk increased as the extent of fibrosis increased (HR: 1.16/5% increase, p = 0.017). All relationships remained significant after multivariate analysis. The extent of fibrosis and nonsustained ventricular tachycardia were univariate predictors for arrhythmic end points (sustained ventricular tachycardia or ventricular fibrillation, appropriate implantable cardioverter-defibrillator discharge, sudden cardiac death) (HR: 1.30, p = 0.014). Nonsustained ventricular tachycardia remained an independent predictor of arrhythmic end points after multivariate analysis, but the extent of fibrosis did not. Conclusions In patients with HCM, myocardial fibrosis as measured by late gadolinium enhancement cardiovascular magnetic resonance is an independent predictor of adverse outcome. (The Prognostic Significance of Fibrosis Detection in Cardiomyopathy; NCT00930735) (J Am Coll Cardiol 2010;56:867-74) (C) 2010 by the American College of Cardiology Foundation

【 授权许可】

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