title: Intermediate-signal-intensity late gadolinium enhancement predicts ventricular tachyarrhythmias in patients with hypertrophic cardiomyopathy.
abstract: BACKGROUND
  In hypertrophic cardiomyopathy (HCM), the arrhythmic potential associated with a variety of left ventricular myocardial signal intensities evident on contrast-enhanced cardiovascular magnetic resonance with late gadolinium enhancement (LGE) is unresolved.
  
  
  RESULTS
  In 145 HCM patients (43±15 years old), visually identified areas of LGE in left ventricle were analyzed quantitatively for intermediate (≥4 but <6 SD) and high (≥6 SD above the mean signal intensity of normal myocardium) LGE signal intensity (LGE-SI). Ambulatory Holter ECGs were obtained within 7.8±8.3 weeks of cardiovascular magnetic resonance. HCM patients with nonsustained ventricular tachycardia, ventricular couplets, and premature ventricular contractions showed greater amounts of intermediate LGE-SI (17±7 versus 10±10 g, 16±10 versus 10±11 g, and 13±8 versus 10±13 g, respectively; P=0.003 to <0.001) and greater amounts of high LGE-SI (15±6 versus 10±8 g, 14±9 versus 10±12 g, and 12±7 versus 10±8 g, respectively; P=0.02-0.003) than patients without these arrhythmias. In HCM patients with either nonsustained ventricular tachycardia, couplets, or premature ventricular contractions, the extent of intermediate LGE-SI exceeded that of high LGE-SI (17±7 versus 15±6 g, 16±10 versus 14±9 g, and 13±8 versus 12±7 g, respectively; P=0.01-0.04). In addition, the receiver operating characteristic area under the curve established intermediate LGE-SI as a better discriminator of patients with nonsustained ventricular tachycardia than was high LGE-SI, with 7 additional patients with this arrhythmia identified.
  
  
  CONCLUSIONS
  In patients with HCM, intermediate LGE-SI is a better predictor of ventricular tachyarrhythmias (including nonsustained ventricular tachycardia, a risk factor for sudden death) than is high LGE-SI. Longitudinal studies in larger HCM cohorts are justified to define the independent prognostic impact of intermediate LGE-SI.
authors.affiliation: PERFUSE Core Laboratory and Data Coordinating Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. eappelba@bidmc.harvard.edu
authors.forename: Evan
authors.initials: E
authors.lastname: Appelbaum
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Maron
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Hauser
authors.forename: John R
authors.initials: JR
authors.lastname: Lesser
authors.forename: Tammy S
authors.initials: TS
authors.lastname: Haas
authors.forename: Anne B
authors.initials: AB
authors.lastname: Riley
authors.forename: Caitlin J
authors.initials: CJ
authors.lastname: Harrigan
authors.forename: Francesca N
authors.initials: FN
authors.lastname: Delling
authors.forename: James E
authors.initials: JE
authors.lastname: Udelson
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
authors.forename: Martin S
authors.initials: MS
authors.lastname: Maron
mesh_terms: D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000473:pathology*; D015331:Cohort Studies; D003287:Contrast Media; D015716:Electrocardiography, Ambulatory; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D011237:Predictive Value of Tests; D017180:Tachycardia, Ventricular / Q000150:complications / Q000473:pathology*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA