CMR-derived LA-GLS identified a HCM low-risk subgroup with only 3% MACE rate, improving risk stratification beyond HCM Risk-SCD score (AUC 0.76).
Does CMR-derived LA-GLS predict major adverse cardiovascular events in patients with hypertrophic cardiomyopathy?
CMR-derived LA-GLS improves risk stratification for major adverse cardiovascular events in patients with hypertrophic cardiomyopathy, particularly by identifying a true low-risk subgroup among those with a low HCM Risk-SCD score.
Absolute Event Rate: 0% vs 0%
Abstract Background Hypertrophic cardiomyopathy (HCM) is associated with diverse cardiovascular outcomes. While the HCM Risk-SCD score effectively stratifies sudden cardiac death (SCD) risk, it provides limited insight into global cardiovascular prognosis, particularly among low-risk patients (HCM Risk-SCD score 4%). Left atrial global longitudinal strain (LA-GLS), derived from cardiovascular magnetic resonance (CMR), may enhance risk stratification by identifying early atrial dysfunction. Purpose This study aimed to assess the prognostic value of CMR-derived LA-GLS in predicting major adverse cardiovascular events (MACE) in a cohort of HCM patients, with a specific focus on those classified as low risk for SCD. Methods Retrospective, longitudinal, single-center study which included 199 HCM patients who underwent CMR. LA-GLS was assessed via feature-tracking and patients were stratified according to the HCM Risk-SCD score. The primary endpoint was a composite of MACE, including ventricular arrhythmias, heart failure, systemic embolisms, and/or all-cause death. Results The mean age of the cohort was 63 ± 17 years, 44% were female, and 92% were categorized as low risk. Over a median follow-up of 6.3 (2.9-8.6) years, 81 patients (41%) experienced MACE. The variables associated with MACE after adjustment were LA-GLS (HR 2.04, 95% CI 1.83/2.28, p = 0.002)(Figure 1A), maximal wall thickness (MWT) (HR 1.11, 95% CI 1.04/1.18, p = 0.002), late gadolinium enhancement (LGE) 5% of total myocardial mass (HR 1.86, 95% CI 1.01/3.45 p = 0.045), and left ventricular ejection fraction (LVEF) 50% (HR 8.62, 95% CI 3.59/20.75, p 0.001). The new CMR-derived model integrated with HCM Risk-SCD score had a significantly enhanced predictive power in identifying MACE, with a combined area under the curve (AUC) of 0.76 (95% CI 0.69-0.82; p = 0.037) (Figure 1B). Among low-risk patients, the risk of MACE was 37%, and the same four variables remained independently associated with the endpoint. A stepwise clinical decision tree was developed to refine risk stratification in this category (Figure 1C). Patients with LVEF 50%, LGE 5%, and with normal LA-GLS (39.2%) had a MACE rate of only 3%, identifying an actual low-risk subgroup. Conclusion CMR-derived LA-GLS is associated with prognosis in HCM and improves risk stratification, especially for patients considered at low risk for SCD. Integrating LA-GLS into clinical workflows may refine management strategies and optimize resource allocation and clinical outcomes.Table 1 Figure 1 (A, B, C)
Ingla et al. (Sat,) reported a other. CMR-derived LA-GLS identified a HCM low-risk subgroup with only 3% MACE rate, improving risk stratification beyond HCM Risk-SCD score (AUC 0.76).