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Myocardial scar, gadolinium enhancement associated with increased odds of cardiac event

Visualization of cardiac scar tissue and gadolinium enhancement on cardiac magnetic resonance (CMR) imaging each predict an increased risk of a major cardiovascular event in patients with hypertrophic cardiomyopathy (HCM), according to two studies published online June 23 in the Journal of the American College of Cardiology.

Oliver Bruder, M.D., of Elisabeth Hospital in Essen, Germany, and colleagues conducted a prospective study in 220 patients of the use of CMR imaging as a risk stratification tool for HCM patients. The investigators found that the presence of a myocardial scar on CMR was associated with a greatly increased risk of both all-cause and cardiac mortality (odds ratios, 5.47 and 8.01, respectively) within a mean follow-up time of 1,090 days. Gadolinium enhancement was also found to be independently associated with an increased risk of death in HCM patients.

In the second study, Rory O'Hanlon, M.D., of the Royal Brompton and Harefield NHS Foundation Trust in London, and colleagues studied the prognostic value of myocardial fibrosis identified with late gadolinium enhancement on CMR in 217 HCM patients. They found that 63 percent of HCM patients showed fibrosis, and of these, 25 percent met the measured end point of a cardiovascular event or cardiac death during the mean 3.1-year follow-up period. In contrast, only 7.4 percent of the HCM patients without fibrosis went on to meet this end point.

"In vivo fibrosis detection by CMR is an independent predictor of adverse outcome in HCM. As a novel marker it seems to detect those at risk of progressive disease and might guide specific therapies for heart failure prevention and treatment. As a risk factor for sudden cardiac death, it is likely that longer follow-up in a larger cohort will clarify the role of fibrosis detection," O'Hanlon and colleagues write.

For the second study, some research support was received from CORDA. Two co-authors disclosed financial ties to pharmaceutical and/or medical device companies.

Source: American College of Cardiology