title: Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy.
abstract: BACKGROUND
  Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden death in the young, although not all patients eligible for sudden death prevention with an implantable cardioverter-defibrillator are identified. Contrast-enhanced cardiovascular magnetic resonance with late gadolinium enhancement (LGE) has emerged as an in vivo marker of myocardial fibrosis, although its role in stratifying sudden death risk in subgroups of HCM patients remains incompletely understood.
  
  
  RESULTS
  We assessed the relation between LGE and cardiovascular outcomes in 1293 HCM patients referred for cardiovascular magnetic resonance and followed up for a median of 3.3 years. Sudden cardiac death (SCD) events (including appropriate defibrillator interventions) occurred in 37 patients (3%). A continuous relationship was evident between LGE by percent left ventricular mass and SCD event risk in HCM patients (P=0.001). Extent of LGE was associated with an increased risk of SCD events (adjusted hazard ratio, 1.46/10% increase in LGE; P=0.002), even after adjustment for other relevant disease variables. LGE of ≥15% of LV mass demonstrated a 2-fold increase in SCD event risk in those patients otherwise considered to be at lower risk, with an estimated likelihood for SCD events of 6% at 5 years. Performance of the SCD event risk model was enhanced by LGE (net reclassification index, 12.9%; 95% confidence interval, 0.3-38.3). Absence of LGE was associated with lower risk for SCD events (adjusted hazard ratio, 0.39; P=0.02). Extent of LGE also predicted the development of end-stage HCM with systolic dysfunction (adjusted hazard ratio, 1.80/10% increase in LGE; P<0.03).
  
  
  CONCLUSIONS
  Extensive LGE measured by quantitative contrast enhanced CMR provides additional information for assessing SCD event risk among HCM patients, particularly patients otherwise judged to be at low risk.
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Chan
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Maron
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Iacopo
authors.initials: I
authors.lastname: Olivotto
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Gabriele Egidy
authors.initials: GE
authors.lastname: Assenza
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Tammy
authors.initials: T
authors.lastname: Haas
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: John R
authors.initials: JR
authors.lastname: Lesser
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Christiane
authors.initials: C
authors.lastname: Gruner
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Crean
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Harry
authors.initials: H
authors.lastname: Rakowski
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: James E
authors.initials: JE
authors.lastname: Udelson
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Ethan
authors.initials: E
authors.lastname: Rowin
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Franco
authors.initials: F
authors.lastname: Cecchi
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Benedetta
authors.initials: B
authors.lastname: Tomberli
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Paolo
authors.initials: P
authors.lastname: Spirito
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Francesco
authors.initials: F
authors.lastname: Formisano
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Carlo Nicola
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Camillo
authors.initials: C
authors.lastname: Autore
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Susie N
authors.initials: SN
authors.lastname: Hong
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.).
authors.forename: Evan
authors.initials: E
authors.lastname: Appelbaum
authors.affiliation: From the PERFUSE Study Group, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C., S.N.H., C.M.B., W.J.M., E.A.); Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN (B.J.M., T.H., J.R.L.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence Italy (I.O., F.C., B.T.); Harvard Clinical Research Institute and Boston University Biostatistics, Boston, MA (M.J.P.); Ospedale Sant'Andrea Universita "La Sapienza," Rome, Italy (G.E.A., C.N.D.C., C.A.); Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (C.G., A.M.C., H.R.); Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U., E.R., M.S.M.); Fondazione C.N.R./Regione Toscana G. Monasterio, Pisa, Italy (M.L.); Ente Ospedaliero Ospedali Galliera, Genoa, Italy (P.S., F.F.); Policlinico S. Orsola-Malpighi, Bologna, Italy (E.B., C.R.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.F.C.). mmaron@tuftsmedicalcenter.org.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Maron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000401:mortality*; D002648:Child; D015331:Cohort Studies; D003287:Contrast Media; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D005682:Gadolinium; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: cardiomyopathies; heart arrest; magnetic resonance imaging