The incremental role of late gadolinium enhancement in risk stratifying high risk patients with hypertrophic cardiomyopathy

Abstract

Background: Current risk stratification models for hypertrophic cardiomyopathy (HCM) rely on a combination of clinical and imaging factors. Recent studies have highlighted the potential role of late gadolinium enhancement (LGE) in enhancing sudden cardiac death (SCD) risk stratification. This study evaluates whether LGE can recalibrate risk stratification models and influence decisions regarding implantable cardioverter-defibrillator (ICD) implantation. We aim to assess the prognostic value of LGE in predicting SCD and its interaction with other established risk factors in patients with HCM.

Methods: We conducted a retrospective cohort study of HCM patients from a multi-site referral center who underwent CMR imaging and had ICDs implanted. We analyzed the incidence of appropriate ICD discharges with LGE presence as an effect modifier.

Results: Out of 326 participants, 50 experienced at least one appropriate ICD discharge over the study period. LGE >15% by itself was significantly associated with a higher rate of appropriate discharges, and significantly adjusted the risk of appropriate discharges in clinical indications such as a family history of SCD and syncope. The study did not find LGE to enhance appropriate ICD discharge risk in patients with already high risk based on imaging features or nonsustained ventricular tachycardia on ambulatory monitoring.

Conclusions: LGE provides incremental prognostic value in refining risk stratification for SCD in HCM patients, especially when the decision for ICD placement may be clinical history alone. This study supports integrating LGE assessments into routine clinical practice to improve the precision of ICD decision-making.