Heart failure & cardiomyopathiesResearch article
Enhanced risk stratification in hypertrophic cardiomyopathy through the integration of extracellular volume fraction on cardiovascular magnetic resonance
- consecutive hypertrophic cardiomyopathy (HCM) patients who underwent cardiovascular magnetic resonance (CMR)
Authors' conclusion
Increased ECV is an independent predictor of HCM-related outcomes. ECV may serve as a novel imaging biomarker to refine risk stratification in HCM patients who do not meet traditional LGE-based high-risk criteria.
Study context
- Population
- Consecutive patients with hypertrophic cardiomyopathy (HCM) who underwent CMR between 2012 and 2024consecutive HCM patients (median age 58 years, male 68.3%)
- Participants
- 990 patients
- Comparison
- Incremental prognostic value of CMR-derived ECV beyond late gadolinium enhancement (LGE) in HCM
- Outcome
- HCM-related events:
- Composite of SCD events
- HF events
- HCM-related death
- Follow-up
- Median 3.2 years
Main finding
As reported in the abstract
Adjusted hazard ratio
1.08 per 1%
95% CI 1.02–1.15
ECV
adjusted HR 1.08 per 1% (95% CI 1.02–1.15)
Per 1%, as printed
- patients experienced the primary endpoint
- 64 (6.5%)
Further findings
LGE and ECV distribution and correlation
- LGE
- median 7.1%, IQR 2.3-16.9%
- ECV
- median 29.0%, IQR 26.6-32.0%
- Correlation LGE vs ECV
- R = 0.604, P < 0.001
Association of LGE and ECV with primary endpoint, sudden cardiac death (SCD) and heart failure (HF) events; optimal cutoffs
- Optimal cutoff LGE
- ≥ 27%
- Optimal cutoff ECV
- ≥ 35%
- Both significantly associated with increased risk of the primary endpoint and individual outcomes of SCD and HF events
Characteristics of patients with ECV ≥ 35%
- More symptoms, a more severe phenotype with greater systolic and diastolic dysfunction, and more pathogenic gene variants
Elevated ECV in lower-risk subgroups
- Elevated ECV effectively identified high-risk individuals even among lower-risk subgroups, including those with low LGE burden
Original publication
Enhanced risk stratification in hypertrophic cardiomyopathy through the integration of extracellular volume fraction on cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging. Published 4 July 2026. doi:10.1093/ehjci/jeag146
Summarised from the published abstract; every number is checked against it