Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy

Rory O'Hanlon, Agata Grasso, Michael Roughton, James C Moon, Susan Clark, Ricardo Wage, Jessica Webb, Meghana Kulkarni, Dana Dawson, Leena Sulaibeekh, Badri Chandrasekaran, Chiara Bucciarelli-Ducci, Ferdinando Pasquale, Martin R Cowie, William J McKenna, Mary N Sheppard, Perry M Elliott, Dudley J Pennell, Sanjay K Prasad

Research output: Contribution to journalArticle

527 Citations (Scopus)

Abstract

Objectives
We investigated the significance of fibrosis detected by late gadolinium enhancement cardiovascular magnetic resonance for the prediction of major clinical events in hypertrophic cardiomyopathy (HCM).

Background
The role of myocardial fibrosis in the prediction of sudden death and heart failure in HCM is unclear with a lack of prospective data.

Methods
We assessed the presence and amount of myocardial fibrosis in HCM patients and prospectively followed them for the development of morbidity and mortality in patients over 3.1 ± 1.7 years.

Results
Of 217 consecutive HCM patients, 136 (63%) showed fibrosis. Thirty-four of the 136 patients (25%) in the fibrosis group but only 6 of 81 (7.4%) patients without fibrosis reached the combined primary end point of cardiovascular death, unplanned cardiovascular admission, sustained ventricular tachycardia or ventricular fibrillation, or appropriate implantable cardioverter-defibrillator discharge (hazard ratio [HR]: 3.4, p = 0.006). In the fibrosis group, overall risk increased with the extent of fibrosis (HR: 1.18/5% increase, p = 0.008). The risk of unplanned heart failure admissions, deterioration to New York Heart Association functional class III or IV, or heart failure-related death was greater in the fibrosis group (HR: 2.5, p = 0.021), and this risk increased as the extent of fibrosis increased (HR: 1.16/5% increase, p = 0.017). All relationships remained significant after multivariate analysis. The extent of fibrosis and nonsustained ventricular tachycardia were univariate predictors for arrhythmic end points (sustained ventricular tachycardia or ventricular fibrillation, appropriate implantable cardioverter-defibrillator discharge, sudden cardiac death) (HR: 1.30, p = 0.014). Nonsustained ventricular tachycardia remained an independent predictor of arrhythmic end points after multivariate analysis, but the extent of fibrosis did not.

Conclusions
In patients with HCM, myocardial fibrosis as measured by late gadolinium enhancement cardiovascular magnetic resonance is an independent predictor of adverse outcome. (The Prognostic Significance of Fibrosis Detection in Cardiomyopathy; NCT00930735)
Original languageEnglish
Pages (from-to)867-874
Number of pages8
JournalJournal of the American College of Cardiology
Volume56
Issue number11
DOIs
Publication statusPublished - 7 Sep 2010

Fingerprint

Hypertrophic Cardiomyopathy
Fibrosis
Ventricular Tachycardia
Heart Failure
Implantable Defibrillators
Gadolinium
Ventricular Fibrillation
Magnetic Resonance Spectroscopy
Multivariate Analysis
Sudden Cardiac Death
Sudden Death
Cardiomyopathies

Keywords

  • adult
  • aged
  • cardiomyopathy, hypertrophic
  • death, sudden
  • female
  • fibrosis
  • humans
  • magnetic resonance imaging
  • male
  • middle aged
  • myocardium
  • prognosis
  • cardiovascular magnetic resonance
  • hypertrophic cardiomyopathy
  • late gadolinium enhancement
  • myocardial fibrosis

Cite this

O'Hanlon, R., Grasso, A., Roughton, M., Moon, J. C., Clark, S., Wage, R., ... Prasad, S. K. (2010). Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. Journal of the American College of Cardiology, 56(11), 867-874. https://doi.org/10.1016/j.jacc.2010.05.010

Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. / O'Hanlon, Rory; Grasso, Agata; Roughton, Michael; Moon, James C; Clark, Susan; Wage, Ricardo; Webb, Jessica; Kulkarni, Meghana; Dawson, Dana; Sulaibeekh, Leena; Chandrasekaran, Badri; Bucciarelli-Ducci, Chiara; Pasquale, Ferdinando; Cowie, Martin R; McKenna, William J; Sheppard, Mary N; Elliott, Perry M; Pennell, Dudley J; Prasad, Sanjay K.

In: Journal of the American College of Cardiology, Vol. 56, No. 11, 07.09.2010, p. 867-874.

Research output: Contribution to journalArticle

O'Hanlon, R, Grasso, A, Roughton, M, Moon, JC, Clark, S, Wage, R, Webb, J, Kulkarni, M, Dawson, D, Sulaibeekh, L, Chandrasekaran, B, Bucciarelli-Ducci, C, Pasquale, F, Cowie, MR, McKenna, WJ, Sheppard, MN, Elliott, PM, Pennell, DJ & Prasad, SK 2010, 'Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy', Journal of the American College of Cardiology, vol. 56, no. 11, pp. 867-874. https://doi.org/10.1016/j.jacc.2010.05.010
O'Hanlon, Rory ; Grasso, Agata ; Roughton, Michael ; Moon, James C ; Clark, Susan ; Wage, Ricardo ; Webb, Jessica ; Kulkarni, Meghana ; Dawson, Dana ; Sulaibeekh, Leena ; Chandrasekaran, Badri ; Bucciarelli-Ducci, Chiara ; Pasquale, Ferdinando ; Cowie, Martin R ; McKenna, William J ; Sheppard, Mary N ; Elliott, Perry M ; Pennell, Dudley J ; Prasad, Sanjay K. / Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. In: Journal of the American College of Cardiology. 2010 ; Vol. 56, No. 11. pp. 867-874.
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title = "Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy",
abstract = "ObjectivesWe investigated the significance of fibrosis detected by late gadolinium enhancement cardiovascular magnetic resonance for the prediction of major clinical events in hypertrophic cardiomyopathy (HCM).BackgroundThe role of myocardial fibrosis in the prediction of sudden death and heart failure in HCM is unclear with a lack of prospective data.MethodsWe assessed the presence and amount of myocardial fibrosis in HCM patients and prospectively followed them for the development of morbidity and mortality in patients over 3.1 ± 1.7 years.ResultsOf 217 consecutive HCM patients, 136 (63{\%}) showed fibrosis. Thirty-four of the 136 patients (25{\%}) in the fibrosis group but only 6 of 81 (7.4{\%}) patients without fibrosis reached the combined primary end point of cardiovascular death, unplanned cardiovascular admission, sustained ventricular tachycardia or ventricular fibrillation, or appropriate implantable cardioverter-defibrillator discharge (hazard ratio [HR]: 3.4, p = 0.006). In the fibrosis group, overall risk increased with the extent of fibrosis (HR: 1.18/5{\%} increase, p = 0.008). The risk of unplanned heart failure admissions, deterioration to New York Heart Association functional class III or IV, or heart failure-related death was greater in the fibrosis group (HR: 2.5, p = 0.021), and this risk increased as the extent of fibrosis increased (HR: 1.16/5{\%} increase, p = 0.017). All relationships remained significant after multivariate analysis. The extent of fibrosis and nonsustained ventricular tachycardia were univariate predictors for arrhythmic end points (sustained ventricular tachycardia or ventricular fibrillation, appropriate implantable cardioverter-defibrillator discharge, sudden cardiac death) (HR: 1.30, p = 0.014). Nonsustained ventricular tachycardia remained an independent predictor of arrhythmic end points after multivariate analysis, but the extent of fibrosis did not.ConclusionsIn patients with HCM, myocardial fibrosis as measured by late gadolinium enhancement cardiovascular magnetic resonance is an independent predictor of adverse outcome. (The Prognostic Significance of Fibrosis Detection in Cardiomyopathy; NCT00930735)",
keywords = "adult, aged, cardiomyopathy, hypertrophic, death, sudden, female, fibrosis, humans, magnetic resonance imaging, male, middle aged, myocardium, prognosis, cardiovascular magnetic resonance, hypertrophic cardiomyopathy, late gadolinium enhancement, myocardial fibrosis",
author = "Rory O'Hanlon and Agata Grasso and Michael Roughton and Moon, {James C} and Susan Clark and Ricardo Wage and Jessica Webb and Meghana Kulkarni and Dana Dawson and Leena Sulaibeekh and Badri Chandrasekaran and Chiara Bucciarelli-Ducci and Ferdinando Pasquale and Cowie, {Martin R} and McKenna, {William J} and Sheppard, {Mary N} and Elliott, {Perry M} and Pennell, {Dudley J} and Prasad, {Sanjay K}",
note = "Copyright {\circledC} 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.",
year = "2010",
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language = "English",
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TY - JOUR

T1 - Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy

AU - O'Hanlon, Rory

AU - Grasso, Agata

AU - Roughton, Michael

AU - Moon, James C

AU - Clark, Susan

AU - Wage, Ricardo

AU - Webb, Jessica

AU - Kulkarni, Meghana

AU - Dawson, Dana

AU - Sulaibeekh, Leena

AU - Chandrasekaran, Badri

AU - Bucciarelli-Ducci, Chiara

AU - Pasquale, Ferdinando

AU - Cowie, Martin R

AU - McKenna, William J

AU - Sheppard, Mary N

AU - Elliott, Perry M

AU - Pennell, Dudley J

AU - Prasad, Sanjay K

N1 - Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2010/9/7

Y1 - 2010/9/7

N2 - ObjectivesWe investigated the significance of fibrosis detected by late gadolinium enhancement cardiovascular magnetic resonance for the prediction of major clinical events in hypertrophic cardiomyopathy (HCM).BackgroundThe role of myocardial fibrosis in the prediction of sudden death and heart failure in HCM is unclear with a lack of prospective data.MethodsWe assessed the presence and amount of myocardial fibrosis in HCM patients and prospectively followed them for the development of morbidity and mortality in patients over 3.1 ± 1.7 years.ResultsOf 217 consecutive HCM patients, 136 (63%) showed fibrosis. Thirty-four of the 136 patients (25%) in the fibrosis group but only 6 of 81 (7.4%) patients without fibrosis reached the combined primary end point of cardiovascular death, unplanned cardiovascular admission, sustained ventricular tachycardia or ventricular fibrillation, or appropriate implantable cardioverter-defibrillator discharge (hazard ratio [HR]: 3.4, p = 0.006). In the fibrosis group, overall risk increased with the extent of fibrosis (HR: 1.18/5% increase, p = 0.008). The risk of unplanned heart failure admissions, deterioration to New York Heart Association functional class III or IV, or heart failure-related death was greater in the fibrosis group (HR: 2.5, p = 0.021), and this risk increased as the extent of fibrosis increased (HR: 1.16/5% increase, p = 0.017). All relationships remained significant after multivariate analysis. The extent of fibrosis and nonsustained ventricular tachycardia were univariate predictors for arrhythmic end points (sustained ventricular tachycardia or ventricular fibrillation, appropriate implantable cardioverter-defibrillator discharge, sudden cardiac death) (HR: 1.30, p = 0.014). Nonsustained ventricular tachycardia remained an independent predictor of arrhythmic end points after multivariate analysis, but the extent of fibrosis did not.ConclusionsIn patients with HCM, myocardial fibrosis as measured by late gadolinium enhancement cardiovascular magnetic resonance is an independent predictor of adverse outcome. (The Prognostic Significance of Fibrosis Detection in Cardiomyopathy; NCT00930735)

AB - ObjectivesWe investigated the significance of fibrosis detected by late gadolinium enhancement cardiovascular magnetic resonance for the prediction of major clinical events in hypertrophic cardiomyopathy (HCM).BackgroundThe role of myocardial fibrosis in the prediction of sudden death and heart failure in HCM is unclear with a lack of prospective data.MethodsWe assessed the presence and amount of myocardial fibrosis in HCM patients and prospectively followed them for the development of morbidity and mortality in patients over 3.1 ± 1.7 years.ResultsOf 217 consecutive HCM patients, 136 (63%) showed fibrosis. Thirty-four of the 136 patients (25%) in the fibrosis group but only 6 of 81 (7.4%) patients without fibrosis reached the combined primary end point of cardiovascular death, unplanned cardiovascular admission, sustained ventricular tachycardia or ventricular fibrillation, or appropriate implantable cardioverter-defibrillator discharge (hazard ratio [HR]: 3.4, p = 0.006). In the fibrosis group, overall risk increased with the extent of fibrosis (HR: 1.18/5% increase, p = 0.008). The risk of unplanned heart failure admissions, deterioration to New York Heart Association functional class III or IV, or heart failure-related death was greater in the fibrosis group (HR: 2.5, p = 0.021), and this risk increased as the extent of fibrosis increased (HR: 1.16/5% increase, p = 0.017). All relationships remained significant after multivariate analysis. The extent of fibrosis and nonsustained ventricular tachycardia were univariate predictors for arrhythmic end points (sustained ventricular tachycardia or ventricular fibrillation, appropriate implantable cardioverter-defibrillator discharge, sudden cardiac death) (HR: 1.30, p = 0.014). Nonsustained ventricular tachycardia remained an independent predictor of arrhythmic end points after multivariate analysis, but the extent of fibrosis did not.ConclusionsIn patients with HCM, myocardial fibrosis as measured by late gadolinium enhancement cardiovascular magnetic resonance is an independent predictor of adverse outcome. (The Prognostic Significance of Fibrosis Detection in Cardiomyopathy; NCT00930735)

KW - adult

KW - aged

KW - cardiomyopathy, hypertrophic

KW - death, sudden

KW - female

KW - fibrosis

KW - humans

KW - magnetic resonance imaging

KW - male

KW - middle aged

KW - myocardium

KW - prognosis

KW - cardiovascular magnetic resonance

KW - hypertrophic cardiomyopathy

KW - late gadolinium enhancement

KW - myocardial fibrosis

U2 - 10.1016/j.jacc.2010.05.010

DO - 10.1016/j.jacc.2010.05.010

M3 - Article

C2 - 20688032

VL - 56

SP - 867

EP - 874

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 11

ER -