Characteristics and Clinical Significance of Late Gadolinium Enhancement by Contrast-Enhanced Magnetic Resonance Imaging in Patients With Hypertrophic Cardiomyopathy

BACKGROUND: Myocardial late gadolinium enhancement (LGE) on contrast-enhanced magnetic resonance imaging (CE-MRI) of patients with hypertrophic cardiomyopathy (HCM) has been suggested to represent intramyocardial fibrosis and, as such, an adverse prognostic risk factor. We evaluated the characteristics of LGE on CE-MRI and explored whether LGE among patients with HCM was associated with genetic testing, severe symptoms, ventricular arrhythmias, or sudden cardiac death (SCD).

METHODS: Four hundred twenty-four patients with HCM (age 55+/-16 years [range 2 to 90], 41% females), without a history of septal ablation/myectomy, underwent CE-MRI (GE 1.5 Tesla). We evaluated the relation between LGE and HCM genes status, severity of symptoms, and the degree of ventricular ectopy on Holter ECG. Subsequent SCD and appropriate implanted cardioverter defibrillator (ICD) therapies were recorded during a mean follow-up of 43+/-14 months (range 16 to 94).

RESULTS: Two hundred thirty-nine patients (56%) had LGE on CE-MRI, ranging from 0.4% to 65% of the left ventricle. Gene-positive patients were more likely to have LGE (P<0.001). The frequencies of New York Heart Association class >3 dyspnea and angina class >or=3 were similar in patients with and without LGE (125 of 239 [52%] versus 94 of 185 [51%] and 24 of 239 [10%] versus 18 of 185 [10%], respectively, P=NS). LGE-positive patients were more likely to have episodes of nonsustained ventricular tachycardia (34 of 126 [27%] versus 8 of 94 [8.5%], P<0.001), had more episodes of nonsustained ventricular tachycardia per patient (4.5+/-12 versus 1.1+/-0.3, P=0.04), and had higher frequency of ventricular extrasystoles/24 hours (700+/-2080 versus 103+/-460, P=0.003). During follow-up, SCD occurred in 4 patients, and additional 4 patients received appropriate ICD discharges. All 8 patients were LGE positive (event rate of 0.94%/y, P=0.01 versus LGE negative). Two additional heart failure-related deaths were recorded among LGE-positive patients. Univariate associates of SCD or appropriate ICD discharge were positive LGE (P=0.002) and presence of nonsustained ventricular tachycardia (P=0.04). The association of LGE with events remained significant after controlling for other risk factors.

CONCLUSIONS: In patients with HCM, presence of LGE on CE-MRI was common and more prevalent among gene-positive patients. LGE was not associated with severe symptoms. However, LGE was strongly associated with surrogates of arrhythmia and remained a significant associate of subsequent SCD and/or ICD discharge after controlling for other variables. If replicated, LGE may be considered an important risk factor for sudden death in patients with HCM. 

PMID: 19850699

Posted in Magnetic Resonance Imaging and tagged , , , , , , , .


  1. Solid data that supports the use of LGE in HOCM patients for risk-stratification.

    The study demonstrates a direct association between the presence of LGE and SCD or appropriate ICD discharges.

  2. It would be interesting whether a quantitative estimate of the degree of enhancement is prognostic as well.

    LV remodeling has also been associated with delayed enhancement in hypertrophic cardiomyopathy. See the related article below:

    Gender-specific differences in left ventricular remodelling and fibrosis in hypertrophic cardiomyopathy: insights from cardiovascular magnetic resonance.
    Schulz-Menger J, Abdel-Aty H, Rudolph A, Elgeti T, Messroghli D, Utz W, Boyé P, Bohl S, Busjahn A, Hamm B, Dietz R.
    Eur J Heart Fail. 2008 Sep;10(9):850-4.

  3. Also check:

    Cardiac magnetic resonance detection of myocardial scarring in hypertrophic cardiomyopathy: correlation with histopathology and prevalence of ventricular tachycardia.
    Kwon DH, Smedira NG, Rodriguez ER, Tan C, Setser R, Thamilarasan M, Lytle BW, Lever HM, Desai MY.
    J Am Coll Cardiol. 2009 Jul 14;54(3):242-9.

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