title: Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  We sought to establish the prognostic value of a comprehensive cardiovascular magnetic resonance (CMR) examination in risk stratification of hypertrophic cardiomyopathy (HCM) patients.
  
  
  BACKGROUND
  With annual mortality rates ranging between 1% and 5%, depending on patient selection, a small but significant number of HCM patients are at risk for an adverse event. Therefore, the identification of and prophylactic therapy (i.e., defibrillator placement) in patients with HCM who are at risk of dying are imperative.
  
  
  METHODS
  Two-hundred forty-three consecutive patients with HCM were prospectively enrolled. All patients underwent initial CMR, and 220 were available for clinical follow-up. The mean follow-up time was 1,090 days after CMR. End points were all-cause and cardiac mortality.
  
  
  RESULTS
  During follow-up 20 of the 220 patients died, and 2 patients survived sudden cardiac death due to adequate implantable cardioverter-defibrillator discharge. Most events (n = 16) occurred for cardiac reasons; the remaining 6 events were related to cancer and accidents. Our data indicate that the presence of scar visualized by CMR yields an odds ratio of 5.47 for all-cause mortality and of 8.01 for cardiac mortality. This might be superior to classic clinical risk factors, because in our dataset the presence of 2 risk factors yields an odds ratio of 3.86 for all-cause and of 2.20 for cardiac mortality, respectively. Multivariable analysis also revealed the presence of late gadolinium enhancement as a good independent predictor of death in HCM patients.
  
  
  CONCLUSIONS
  Among our population of largely low or asymptomatic HCM patients, the presence of scar indicated by CMR is a good independent predictor of all-cause and cardiac mortality.
authors.affiliation: Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bruder
authors.forename: Anja
authors.initials: A
authors.lastname: Wagner
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Jensen
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Peter
authors.initials: P
authors.lastname: Ong
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Kispert
authors.forename: Kai
authors.initials: K
authors.lastname: Nassenstein
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlosser
authors.forename: Georg V
authors.initials: GV
authors.lastname: Sabin
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.forename: Heiko
authors.initials: H
authors.lastname: Mahrholdt
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000401:mortality*; D002921:Cicatrix / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors