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European Heart Journal Advance Access published online on May 27, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp152
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Usefulness of cardiac magnetic resonance in assessing the risk of ventricular arrhythmias and sudden death in patients with hypertrophic cardiomyopathy

Sergio Leonardi1, Claudia Raineri1,*, Gaetano M. De Ferrari1, Stefano Ghio1, Laura Scelsi1, Michele Pasotti2, Marilena Tagliani2, Adele Valentini3, Roberto Dore3, Arturo Raisaro1 and Eloisa Arbustini2

1 Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia (PV), Italy
2 Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, Policlinico San Matteo, Pavia (PV), Italy
3 Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia (PV), Italy

Received 1 August 2008; revised 3 February 2009; accepted 17 March 2009 * Corresponding author. Tel: +39 0 382501034, Fax: +39 0 382503161, Email: c.raineri{at}smatteo.pv.it

Aims: To assess the relationship between cardiovascular magnetic resonance (CMR) parameters and both spontaneous ventricular tachycardia (VT) and risk of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) patients.

Methods and results: One hundred and eight consecutive HCM patients (mean age 42 ± 15 years, 76% males) underwent CMR evaluation and risk assessment. Delayed contrast enhancement (DCE) was quantified with a specifically designed score. Endpoints were either the presence of clinical VT/ventricular fibrillation (VF) or of acknowledged risk factors for SCD. Compared to patients without arrhythmia, those with VT/VF (n = 33) had a higher DCE score [median 8 (2–13) vs. 11 (6–20); P = 0.01]; DCE score was also the only independent predictor of VT/VF in the multivariable model. DCE score [median 6 (1–10.5) vs. 12 (6–18); P = 0.001], mean and maximal left ventricular (LV) wall thickness (MaxLVWT), as well as LV mass index were significantly greater among patients at risk for SCD (n = 51) compared with the remaining 57 patients at low risk. DCE score and MaxLVWT were independent predictors of SCD risk.

Conclusion: In HCM patients several CMR parameters are associated with risk for SCD. A semi-quantitative index of DCE is a significant multivariable predictor of both clinical VT/VF and of risk for SCD and may contribute to risk assessment in borderline or controversial cases.

Key Words: Cardiovascular magnetic resonance • Sudden cardiac death • Hypertrophic cardiomyopathy • Ventricular tachycardia/fibrillation


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