Usefulness of Tissue Tracking by Cardiac Magnetic Resonance to Predict Events in Patients With Hypertrophic Cardiomyopathy

https://doi.org/10.1016/j.amjcard.2022.03.024Get rights and content

Hypertrophic cardiomyopathy (HC) is the most common cardiovascular inherited disease, and it is associated with arrhythmic events, heart failure, and death. Strain analysis by tissue tracking (TT) techniques on cardiac magnetic resonance (CMR) is a novel noninvasive diagnostic tool. However, the usefulness of CMR-TT to identify patients with HC at risk of adverse outcomes remains unknown. CMR strain parameters by CMR-TT were prospectively measured in a cohort of 136 consecutive patients with HC. Clinical (death or readmission for heart failure) and arrhythmic (any ventricular tachycardia) events during follow-up were prospectively recorded. Global radial systolic strain rate and global radial diastolic strain rate showed the best area under the receiver operating characteristic curve (ROC curve) to predict adverse clinical events. On Cox multivariate regression models, a global radial systolic strain rate value <1.4/s and a global radial diastolic strain rate value ≥ −1.38/s were independently associated with clinical events at follow-up (adjusted hazard ratio 6.57, 95% confidence interval [CI] 2.01 to 21.49, p = 0.002; adjusted hazard ratio 5.96, 95% CI 1.79 to 19.89, p = 0.004, respectively). Regarding arrhythmic events, global radial peak strain <27% showed the best area under the ROC curve and remained independently associated with ventricular tachycardia after adjustment for confounders (odds ratio 7.33, 95% CI 1.07 to 50.41, p = 0.043). CMR strain parameters by TT predict clinical and arrhythmic events in patients with HC.

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Methods

All patients diagnosed with HC by CMR presenting to our tertiary hospital from January 2006 to October 2017 were consecutively enrolled. The diagnosis of HC was established as an otherwise unexplained wall thickness of ≥15 mm in 1 or more left ventricle segments (or ≥13 mm in first degree relatives of patients with HC).2 All patients with HC were prospectively followed and managed in a dedicated HC outpatient clinic6 according to the clinical practice guidelines of the European Society of

Results

A total of 165 consecutive patients were initially enrolled, of whom 23 had to be excluded because of poor CMR study quality. In addition, 6 patients showed typical ischemic LGE and were, therefore, also excluded from ulterior analysis. Hence, the final population consisted of 136 consecutive patients that were analyzed and prospectively followed. The mean age was 60.8 ± 15 years and, 42 were women (31%). The mean LV ejection fraction by echocardiography was 69 ± 9%. Most of the patients were

Discussion

This is one of the first studies to explore the value of CMR-TT as a predictor of clinical and arrhythmic events in patients with HC. The main findings of the study are as follow. Radial strain and strain rate parameters were the best predictors of clinical and arrhythmic events. In terms of clinical events, systolic and diastolic radial strain rates (GRSsr and GRDsr, respectively) were associated with the occurrence of all-cause death or admission for heart failure on follow-up when their

Disclosures

The authors have no conflicts of interest to declare.

References (28)

Drs. Martínez-Vives and Cecconi contributed equally to this manuscript.

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