Late Gadolinium Enhancement-Dispersion Mapping: A New Magnetic Resonance Imaging Technique to Assess Prognosis in Patients With Hypertrophic Cardiomyopathy and Low-Intermediate 5-Year Risk of Sudden Death

Circ Cardiovasc Imaging. 2020 Jun;13(6):e010489. doi: 10.1161/CIRCIMAGING.120.010489. Epub 2020 Jun 16.

Abstract

Background: Late gadolinium enhancement (LGE) is an important prognostic marker in hypertrophic cardiomyopathy and an extent >15% it is associated with high risk of sudden cardiac death. We proposed a novel method, the LGE-dispersion mapping, to assess heterogeneity of scar, and evaluated its prognostic role in patients with hypertrophic cardiomyopathy.

Methods: One hundred eighty-three patients with hypertrophic cardiomyopathy and a low- or intermediate 5-year risk of sudden cardiac death underwent cardiac magnetic resonance imaging. A parametric map was generated from each LGE image. A score from 0 to 8 was assigned at every pixel of these maps, indicating the number of the surrounding pixels having different quality (nonenhancement, mild-enhancement, or hyperenhancement) from the central pixel. The Global Dispersion Score (GDS) was calculated as the average score of all the pixels of the images.

Results: During a median follow-up time of 6 (25th-75th, 4-10) years, 22 patients had hard cardiac events (sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, resuscitated cardiac arrest, and sustained ventricular tachycardia). Kaplan-Meier analysis showed that patients with GDS>0.86 had worse prognosis than those with lower GDS (P<0.0001). GDS>0.86 was the only independent predictor of cardiac events (hazard ratio, 9.9 [95% CI, 2.9-34.6], P=0.0003). When compared with LGE extent >15%, GDS improved the classification of risk in these patients (net reclassification improvement, 0.39 [95% CI, 0.11-0.72], P<0.019).

Conclusions: LGE-dispersion mapping is a marker of scar heterogeneity and provides a better risk stratification than LGE presence and its extent in patients with hypertrophic cardiomyopathy and a low-intermediate 5-year risk of sudden cardiac death.

Keywords: cardiomyopathy; death; gadolinium; prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cardiomyopathy, Hypertrophic / complications
  • Cardiomyopathy, Hypertrophic / diagnostic imaging*
  • Cardiomyopathy, Hypertrophic / mortality
  • Cardiomyopathy, Hypertrophic / therapy
  • Contrast Media / administration & dosage*
  • Death, Sudden, Cardiac / etiology*
  • Death, Sudden, Cardiac / prevention & control
  • Female
  • Humans
  • Magnetic Resonance Imaging, Cine*
  • Male
  • Meglumine / administration & dosage*
  • Middle Aged
  • Myocardium / pathology*
  • Organometallic Compounds / administration & dosage*
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Time Factors

Substances

  • Contrast Media
  • Organometallic Compounds
  • Meglumine
  • gadoterate meglumine