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Erschienen in: European Radiology 12/2017

14.06.2017 | Cardiac

Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR

verfasst von: Maxim Avanesov, Julia Münch, Julius Weinrich, Lennart Well, Dennis Säring, Christian Stehning, Enver Tahir, Sebastian Bohnen, Ulf K. Radunski, Kai Muellerleile, Gerhard Adam, Monica Patten, Gunnar Lund

Erschienen in: European Radiology | Ausgabe 12/2017

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Abstract

Objectives

To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT).

Methods

A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT.

Results

Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT.

Conclusions

Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators.

Key Points

Global ECV identified the best HCM patients with increased SCD risk.
Global ECV performed equally well compared to a SCD risk score.
Combined use of the SCD risk score and global ECV improved test accuracy.
Combined use potentially improves selection of HCM patients for ICD implantation.
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Literatur
1.
Zurück zum Zitat Maron BJ (2009) Distinguishing hypertrophic cardiomyopathy from athlete’s heart physiological remodelling: clinical significance, diagnostic strategies and implications for preparticipation screening. Br J Sports Med 43:649–656CrossRefPubMed Maron BJ (2009) Distinguishing hypertrophic cardiomyopathy from athlete’s heart physiological remodelling: clinical significance, diagnostic strategies and implications for preparticipation screening. Br J Sports Med 43:649–656CrossRefPubMed
2.
Zurück zum Zitat Gersh BJ, Maron BJ, Bonow RO et al (2011) 2011 ACCF/AHA Guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary. J Am Coll Cardiol 58:2703–2738CrossRefPubMed Gersh BJ, Maron BJ, Bonow RO et al (2011) 2011 ACCF/AHA Guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary. J Am Coll Cardiol 58:2703–2738CrossRefPubMed
3.
Zurück zum Zitat O’Mahony C, Jichi F, Pavlou M et al (2014) A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM Risk-SCD). Eur Heart J 35:2010–2020CrossRefPubMed O’Mahony C, Jichi F, Pavlou M et al (2014) A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM Risk-SCD). Eur Heart J 35:2010–2020CrossRefPubMed
4.
Zurück zum Zitat Elliott PM, Anastasakis A, Borger MA et al (2014) 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35:2733–2779CrossRefPubMed Elliott PM, Anastasakis A, Borger MA et al (2014) 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35:2733–2779CrossRefPubMed
5.
Zurück zum Zitat Ruiz-Salas A, García-Pinilla J, Cabrera-Bueno F, et al. Comparison of the new risk prediction model (HCM Risk-SCD) and classic risk factors for sudden death in patients with hypertrophic cardiomyopathy and defibrillator. Europace. 2015:3–7. doi:10.1093/europace/euv079 Ruiz-Salas A, García-Pinilla J, Cabrera-Bueno F, et al. Comparison of the new risk prediction model (HCM Risk-SCD) and classic risk factors for sudden death in patients with hypertrophic cardiomyopathy and defibrillator. Europace. 2015:3–7. doi:10.​1093/​europace/​euv079
6.
Zurück zum Zitat Kuruvilla S, Adenaw N, Katwal AB et al (2014) Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis. Circ Cardiovasc Imaging 7:250–258CrossRefPubMed Kuruvilla S, Adenaw N, Katwal AB et al (2014) Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis. Circ Cardiovasc Imaging 7:250–258CrossRefPubMed
7.
Zurück zum Zitat Bruder O, Wagner A, Jensen CJ et al (2010) Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 56:875–887CrossRefPubMed Bruder O, Wagner A, Jensen CJ et al (2010) Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 56:875–887CrossRefPubMed
8.
Zurück zum Zitat O’Hanlon R, Grasso A, Roughton M et al (2010) Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol 56:867–874CrossRefPubMed O’Hanlon R, Grasso A, Roughton M et al (2010) Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol 56:867–874CrossRefPubMed
9.
Zurück zum Zitat Maron MS, Appelbaum E, Harrigan CJ et al (2008) Clinical profile and significance of delayed enhancement in hypertrophic cardiomyopathy. Circ Heart Fail 1:184–191CrossRefPubMed Maron MS, Appelbaum E, Harrigan CJ et al (2008) Clinical profile and significance of delayed enhancement in hypertrophic cardiomyopathy. Circ Heart Fail 1:184–191CrossRefPubMed
10.
Zurück zum Zitat Mewton N, Liu CY, Croisille P et al (2011) Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 57:891–903CrossRefPubMed Mewton N, Liu CY, Croisille P et al (2011) Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 57:891–903CrossRefPubMed
11.
Zurück zum Zitat Ellims AH, Iles LM, Ling L et al (2012) Diffuse myocardial fibrosis in hypertrophic cardiomyopathy can be identified by cardiovascular magnetic resonance, and is associated with left ventricular diastolic dysfunction. J Cardiovasc Magn Reson 14:76CrossRefPubMedPubMedCentral Ellims AH, Iles LM, Ling L et al (2012) Diffuse myocardial fibrosis in hypertrophic cardiomyopathy can be identified by cardiovascular magnetic resonance, and is associated with left ventricular diastolic dysfunction. J Cardiovasc Magn Reson 14:76CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Flett AS, Hayward MP, Ashworth MT et al (2010) Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation 122:138–144CrossRefPubMed Flett AS, Hayward MP, Ashworth MT et al (2010) Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation 122:138–144CrossRefPubMed
14.
Zurück zum Zitat Kammerlander AA, Marzluf BA, Zotter-Tufaro C et al (2016) T1 Mapping by CMR imaging from histological validation to clinical implication. J Am Coll Cardiol Img 9:14–23CrossRef Kammerlander AA, Marzluf BA, Zotter-Tufaro C et al (2016) T1 Mapping by CMR imaging from histological validation to clinical implication. J Am Coll Cardiol Img 9:14–23CrossRef
15.
Zurück zum Zitat Diao K, Yang Z, Xu H et al (2017) Histologic validation of myocardial fibrosis measured by T1 mapping: a systematic review and meta-analysis. J Cardiovasc Magn Reson 18:92CrossRef Diao K, Yang Z, Xu H et al (2017) Histologic validation of myocardial fibrosis measured by T1 mapping: a systematic review and meta-analysis. J Cardiovasc Magn Reson 18:92CrossRef
16.
Zurück zum Zitat Miller CA, Naish JH, Bishop P, et al. (201 3) Comprehensive validation of cardiovascular magnetic resonance techniques for the assessment of myocardial extracellular volume. Circ Cardiovasc Imaging 6:373–383. doi:10.1161/CIRCIMAGING.112.000192 Miller CA, Naish JH, Bishop P, et al. (201 3) Comprehensive validation of cardiovascular magnetic resonance techniques for the assessment of myocardial extracellular volume. Circ Cardiovasc Imaging 6:373–383. doi:10.​1161/​CIRCIMAGING.​112.​000192
18.
Zurück zum Zitat Maron MS, Olivotto I, Betocchi S et al (2003) Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med 348:295–303CrossRefPubMed Maron MS, Olivotto I, Betocchi S et al (2003) Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med 348:295–303CrossRefPubMed
19.
Zurück zum Zitat Schulz-Menger J, Bluemke DA, Bremerich J et al (2013) Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) Board of Trustees Task Force on Standardized Post Processing. J Cardiovasc Magn Reson 15:35CrossRefPubMedPubMedCentral Schulz-Menger J, Bluemke DA, Bremerich J et al (2013) Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) Board of Trustees Task Force on Standardized Post Processing. J Cardiovasc Magn Reson 15:35CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Ugander M, Oki AJ, Hsu LY et al (2012) Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J 33:1268–1278CrossRefPubMedPubMedCentral Ugander M, Oki AJ, Hsu LY et al (2012) Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J 33:1268–1278CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Säring D, Ehrhardt J, Stork A et al (2006) Computer-assisted analysis of 4D cardiac MR image sequences after myocardial infarction. Methods Inf Med 45:377–383PubMed Säring D, Ehrhardt J, Stork A et al (2006) Computer-assisted analysis of 4D cardiac MR image sequences after myocardial infarction. Methods Inf Med 45:377–383PubMed
23.
Zurück zum Zitat Mikami Y, Kolman L, Joncas SX et al (2014) Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:85CrossRefPubMedPubMedCentral Mikami Y, Kolman L, Joncas SX et al (2014) Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:85CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Moravsky G, Ofek E, Rakowski H et al (2013) Myocardial fibrosis in hypertrophic cardiomyopathy: accurate reflection of histopathological findings by CMR. J Am Coll Cardiol Img 6:587–596CrossRef Moravsky G, Ofek E, Rakowski H et al (2013) Myocardial fibrosis in hypertrophic cardiomyopathy: accurate reflection of histopathological findings by CMR. J Am Coll Cardiol Img 6:587–596CrossRef
25.
Zurück zum Zitat Flett AS, Hasleton J, Cook C et al (2011) Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance. J Am Coll Cardiol Img 4:150–156CrossRef Flett AS, Hasleton J, Cook C et al (2011) Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance. J Am Coll Cardiol Img 4:150–156CrossRef
26.
Zurück zum Zitat Hamshere S, Jones DA, Pellaton C et al (2016) Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: is whole heart coverage necessary? J Cardiovasc Magn Reson 18:7CrossRefPubMedPubMedCentral Hamshere S, Jones DA, Pellaton C et al (2016) Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: is whole heart coverage necessary? J Cardiovasc Magn Reson 18:7CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Karlsen OT, Verhagen R, Bovée WMMJ (1999) Parameter estimation from Rician-distributed data sets using a maximum likelihood estimator: application to T1 and perfusion measurements. Magn Reson Med 41:614–623CrossRefPubMed Karlsen OT, Verhagen R, Bovée WMMJ (1999) Parameter estimation from Rician-distributed data sets using a maximum likelihood estimator: application to T1 and perfusion measurements. Magn Reson Med 41:614–623CrossRefPubMed
28.
Zurück zum Zitat Green JJ, Berger JS, Kramer CM, Salerno M (2012) Prognostic value of late gadolinium enhancement in clinical outcomes for hypertrophic cardiomyopathy. J Am Coll Cardiol Img 5:370–377CrossRef Green JJ, Berger JS, Kramer CM, Salerno M (2012) Prognostic value of late gadolinium enhancement in clinical outcomes for hypertrophic cardiomyopathy. J Am Coll Cardiol Img 5:370–377CrossRef
29.
Zurück zum Zitat Chan RH, Maron BJ, Olivotto I et al (2014) Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 130:484–495. Chan RH, Maron BJ, Olivotto I et al (2014) Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 130:484–495.
30.
Zurück zum Zitat Puntmann VO, Voigt T, Chen Z et al (2013) Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated cardiomyopathy. J Am Coll Cardiol Img 6:475–484CrossRef Puntmann VO, Voigt T, Chen Z et al (2013) Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated cardiomyopathy. J Am Coll Cardiol Img 6:475–484CrossRef
31.
Zurück zum Zitat Dass S, Suttie JJ, Piechnik SK et al (2012) Myocardial tissue characterization using magnetic resonance noncontrast T1 mapping in hypertrophic and dilated cardiomyopathy. Circ Cardiovasc Imaging 5:726–733CrossRefPubMed Dass S, Suttie JJ, Piechnik SK et al (2012) Myocardial tissue characterization using magnetic resonance noncontrast T1 mapping in hypertrophic and dilated cardiomyopathy. Circ Cardiovasc Imaging 5:726–733CrossRefPubMed
32.
Zurück zum Zitat Kali A, Cokic I, Tang RLQ et al (2014) Determination of location, size, and transmurality of chronic myocardial infarction without exogenous contrast media by using cardiac magnetic resonance imaging at 3 T. Circ Cardiovasc Imaging 7:471–481CrossRefPubMedPubMedCentral Kali A, Cokic I, Tang RLQ et al (2014) Determination of location, size, and transmurality of chronic myocardial infarction without exogenous contrast media by using cardiac magnetic resonance imaging at 3 T. Circ Cardiovasc Imaging 7:471–481CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Wong TC, Piehler K, Meier CG et al (2012) Association between extracellular matrix expansion quantified by cardiovascular magnetic resonance and short-term mortality. Circulation 126:1206–1216CrossRefPubMedPubMedCentral Wong TC, Piehler K, Meier CG et al (2012) Association between extracellular matrix expansion quantified by cardiovascular magnetic resonance and short-term mortality. Circulation 126:1206–1216CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Schelbert EB, Piehler KM, Zareba KM et al (2015) Myocardial fibrosis quantified by extracellular volume is associated with subsequent hospitalization for heart failure, death, or both across the spectrum of ejection fraction and heart failure stage. J Am Heart Assoc 4, e002613. doi:10.1161/JAHA.115.002613 CrossRefPubMedPubMedCentral Schelbert EB, Piehler KM, Zareba KM et al (2015) Myocardial fibrosis quantified by extracellular volume is associated with subsequent hospitalization for heart failure, death, or both across the spectrum of ejection fraction and heart failure stage. J Am Heart Assoc 4, e002613. doi:10.​1161/​JAHA.​115.​002613 CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Basso C, Thiene G, Corrado D et al (2000) Hypertrophic cardiomyopathy and sudden death in the young: pathologic evidence of myocardial ischemia. Hum Pathol 31:988–998CrossRefPubMed Basso C, Thiene G, Corrado D et al (2000) Hypertrophic cardiomyopathy and sudden death in the young: pathologic evidence of myocardial ischemia. Hum Pathol 31:988–998CrossRefPubMed
36.
Zurück zum Zitat Shirani J, Pick R, Roberts WC, Maron BJ (2000) Morphology and significance of the left ventricular collagen network in young patients with hypertrophic cardiomyopathy and sudden cardiac death. J Am Coll Cardiol 35:36–44CrossRefPubMed Shirani J, Pick R, Roberts WC, Maron BJ (2000) Morphology and significance of the left ventricular collagen network in young patients with hypertrophic cardiomyopathy and sudden cardiac death. J Am Coll Cardiol 35:36–44CrossRefPubMed
Metadaten
Titel
Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR
verfasst von
Maxim Avanesov
Julia Münch
Julius Weinrich
Lennart Well
Dennis Säring
Christian Stehning
Enver Tahir
Sebastian Bohnen
Ulf K. Radunski
Kai Muellerleile
Gerhard Adam
Monica Patten
Gunnar Lund
Publikationsdatum
14.06.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 12/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-4869-x

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