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Eur Radiol. 2017 Dec;27(12):5136-5145. doi: 10.1007/s00330-017-4869-x. Epub 2017 Jun 14.

Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR.

Author information

1
Department of Diagnostic and Interventional Radiology, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
2
Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
3
DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany.
4
Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany.
5
Philips Research, Hamburg, Germany.
6
Department of Diagnostic and Interventional Radiology, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. glund@uke.de.

Abstract

OBJECTIVES:

To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT).

METHODS:

A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT.

RESULTS:

Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT.

CONCLUSIONS:

Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators.

KEY POINTS:

• Global ECV identified the best HCM patients with increased SCD risk. • Global ECV performed equally well compared to a SCD risk score. • Combined use of the SCD risk score and global ECV improved test accuracy. • Combined use potentially improves selection of HCM patients for ICD implantation.

KEYWORDS:

Extracellular volume; Hypertrophic cardiomyopathy; Late gadolinium enhancement; Prognosis; Risk assessment

PMID:
28616729
DOI:
10.1007/s00330-017-4869-x
[Indexed for MEDLINE]

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