Heart failure & cardiomyopathies
Assessment of late gadolinium enhancement in hypertrophic cardiomyopathy improves risk stratification based on current guidelines
Authors' conclusion
The 2022 ESC model performed better than the 2014 ESC model with especially improved sensitivity. LGE enabled further risk stratification based on current guidelines.
Study context
- Population
- Consecutive patients with hypertrophic cardiomyopathy (HCM) who underwent CMR46 (5.9%) reached sudden cardiac death (SCD) endpoint
- Participants
- 774 patients
- Exposure
- 2022 European Society of Cardiology (ESC) model vs 2014 ESC model and other guideline-based ICD class of recommendation (ICD-COR) models; Late gadolinium enhancement (LGE) for further risk stratification
- Outcome
- SCD-related endpoint
- Follow-up
- 7.4 ± 2.5 years
Methodological detailsconsecutive patients, external validation
- Consecutive patients
- External validation
Main finding
As reported in the abstract
SCD prediction performance
| Strategy | AUC | C-statistic | Sensitivity | PPV | NPV |
|---|---|---|---|---|---|
| 2022 ESC | .76 | .78 | 76.1% | 16.8% | 98.1% |
| 2014 ESC | .63 | .64 | 43.5% | 13.6% | 95.9% |
| 2011 American College of Cardiology (ACC)/American Heart Association (AHA) | — not stated in the abstract | .68 | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract |
| 2020 AHA/ACC | — not stated in the abstract | .76 | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract |
AUC
2022 ESC.76
2014 ESC.63
2011 American College of Cardiology (ACC)/American Heart Association (AHA)— not stated in the abstract
2020 AHA/ACC— not stated in the abstract
C-statistic
2022 ESC.78
2014 ESC.64
2011 American College of Cardiology (ACC)/American Heart Association (AHA).68
2020 AHA/ACC.76
Sensitivity
2022 ESC76.1%
2014 ESC43.5%
2011 American College of Cardiology (ACC)/American Heart Association (AHA)— not stated in the abstract
2020 AHA/ACC— not stated in the abstract
PPV
2022 ESC16.8%
2014 ESC13.6%
2011 American College of Cardiology (ACC)/American Heart Association (AHA)— not stated in the abstract
2020 AHA/ACC— not stated in the abstract
NPV
2022 ESC98.1%
2014 ESC95.9%
2011 American College of Cardiology (ACC)/American Heart Association (AHA)— not stated in the abstract
2020 AHA/ACC— not stated in the abstract
— not stated in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | SCD | No SCD | P value |
|---|---|---|---|
| ESC Risk-SCD score and LGE extent, SCD vs no SCD · 7.4 ± 2.5 years of follow-up | |||
| ESC Risk-SCD score | 4.3 ± 2.4% | 2.8 ± 2.1% | P < 0.001 |
| LGE extent | 13.7 ± 9.4% | 4.9 ± 6.6% | P < 0.001 |
C-statistics for SCD prediction
- 2011 ACC/AHA model
- .68
- 2014 ESC model
- .64
- 2020 AHA/ACC model
- .76
- 2022 ESC model
- .78
SCD risk with LGE ≥5% (patients without extensive LGE)
- LGE ≥5% responsible for seven-fold SCD risk after multivariable adjustment
Prognosis by LGE within ICD-COR II or ICD-COR III
- LGE ≥5% and <15% significantly worse prognosis than LGE <5%
- all P < .001
Original publication
Assessment of late gadolinium enhancement in hypertrophic cardiomyopathy improves risk stratification based on current guidelines. Eur Heart J. Published 5 October 2023. doi:10.
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