Extent of Late Gadolinium Enhancement Predicts Thromboembolic Events in Patients With Hypertrophic Cardiomyopathy

Abstract

Background: Thromboembolic complications such as ischemic stroke or peripheral arterial thromboembolism are known complications in hypertrophic cardiomyopathy (HCM). We sought to assess the clinical and cardiovascular magnetic resonance (CMR) characteristics of patients with HCM suffering from thromboembolic events and analyzed the predictors of these unfavorable outcomes. Methods and Results: The 115 HCM patients underwent late gadolinium enhanced (LGE) CMR and were included in the study. Follow-up was 5.6±3.6 years. The primary endpoint was the occurrence of thromboembolic events (ischemic stroke or peripheral arterial thromboembolism). It occurred in 17 (14.8%) patients (event group, EG), of whom 64.7% (11) were men. During follow-up, 10 (8.7%) patients died. Patients in the EG showed more comorbidities, such as heart failure (EG 41.2% vs. NEG (non-event group) 14.3%, P<0.01) and atrial fibrillation (AF: EG 70.6% vs. NEG 36.7%, P<0.01). Left atrial end-diastolic volume was significantly higher in the EG (EG 73±24 vs. NEG 50±33 mL/m 2 , P<0.01). Both the presence and extent of LGE were enhanced in the EG (extent% EG 23±15% vs. NEG 8±9%, P<0.0001). No patient without LGE experienced a thromboembolic event. Multivariate analysis revealed AF and LGE extent as independent predictors. Conclusions: LGE extent (>14.4%) is an independent predictor for thromboembolic complications in patients with HCM and might therefore be considered as an important risk marker. The risk for thromboembolic events is significantly elevated if accompanied by AF.

Importance of Paroxysmal Atrial Fibrillation and Sex Differences in the Prevention of Embolic Stroke in Hypertrophic Cardiomyopathy

“…Further to left atrial size and function, a recent study using cardiac magnetic resonance imaging demonstrated that HCM patients with paroxysmal AF have a greater extent of left atrial wall fibrosis on late gadolinium enhancement, together with a number of other functional and morphological features. 36 This association between AF and left atrial late gadolinium enhancement indicates the importance of assessing not only LV fibrosis, 37 but also left atrial fibrosis as an important adverse marker in HCM patients. In this context, the recently proposed concept of atrial failure 38 may also be relevant to the HCM population, because the presence of atrial failure may predispose a patient to new-onset AF.…”

Cardiovascular magnetic resonance imaging and its role in the investigation of stroke: an update

“…CMR LGE extent (> 14.4%) has been found to be an independent predictor for thromboembolic complications in patients with HCM [56].…”

Utilidad de la resonancia magnética cardíaca en el diagnóstico de cardiomiopatías

“…2022;12 (4) Utilidad de la resonancia magnética cardíaca Artículo de revisión que tienen más del 15% de fibrosis miocárdica dos veces mayor el riesgo de desarrollar muerte cardíaca súbita. (29,30) Adicionalmente el T1 mapping se encuentra incrementado al igual que el volumen extracelular (31,32) incluso en áreas donde no se observe hipertrofia (genotipo positivo, fenotipo negativo). (33,34) (Figura 3)…”