Arrhythmias & electrophysiology
Scar architecture as a structural biomarker of ventricular arrhythmias and sudden cardiac death in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance study
Authors' conclusion
Scar composition and its organization in BZ channels provides strong, independent prognostic value for VT/VF in HCM, improving existing clinical risk stratification tools.
Study context
- Population
- Hypertrophic cardiomyopathy (HCM) patients who underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR)298 of whom (72.6%) had LGE at CMR (LGE+)
- Participants
- Four-hundred-ten patients
- Exposure
- Scar components, alone or combined with ESC or ACC/AHA risk scores, as predictors of a composite VT/VF endpoint
- VT/VF patientsn = 26
- Outcome
- Scar components (% of LV mass)
Methodological detailsretrospective
- Retrospective
Main finding
As reported in the abstract
Total scar
7.3%
IQR: 0.0–14.3
Borderzone (BZ)
6.4%
IQR: 0.0–12.2
Core mass
0.9%
IQR: 0.0–2.1
BZ channels found in
140 (34.1%) patients
Observational data: associations, not effects.
Further findings
BZ channels observed
P < 0.001
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| VT/VF risk per BZ channels massBZ channels mass · after adjustment for ESC risk estimate | 1.45 (1.26–1.67) | P < 0.0001 | |
| VT/VF risk per BZ channels massBZ channels mass · after adjustment for AHA/ACC risk estimate | 1.34 (1.16–1.54) | P < 0.0001 | |
| 0.512Hazard ratio (log scale) |
| Outcome | P value |
|---|---|
| Total scar, BZ and core massHigher in VT/VF patients | P < 0.001 |
Composite VT/VF endpoint · 65 months; IQR: 36-95
- Patients met the endpoint
- 26 (6.3%)
BZ channels observed
- Patients with BZ channels had higher incidence of VT/VF
Predictive performance with BZ channel mass integrated
- ESC model NRI
- 0.19, P = 0.03
- AHA/ACC model NRI
- 0.32, P < 0.001
Original publication
Scar architecture as a structural biomarker of ventricular arrhythmias and sudden cardiac death in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging. Published 28 October 2025. doi:10.
Summarised from the published abstract; every number is checked against it