Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathy
ABSTRACT: Background: The extent of late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM) is associated with an increased risk of sudden cardiac death events. However, the clinical significance of age-specific longitudinal ch...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-01-01
|
| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1097664724010998 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850119339095621632 |
|---|---|
| author | Shiro Nakamori Ethan J. Rowin Jennifer Rodriguez Long H. Ngo Warren J. Manning Martin Maron Reza Nezafat |
| author_facet | Shiro Nakamori Ethan J. Rowin Jennifer Rodriguez Long H. Ngo Warren J. Manning Martin Maron Reza Nezafat |
| author_sort | Shiro Nakamori |
| collection | DOAJ |
| description | ABSTRACT: Background: The extent of late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM) is associated with an increased risk of sudden cardiac death events. However, the clinical significance of age-specific longitudinal changes in LGE is not well characterized in HCM. We sought to assess whether the risk of LGE progression diverges between young to middle-aged (ages 20-59 years) and older (≥ 60) adults with HCM. Methods: A total of 102 HCM patients (age <60 years; n=75, age ≥60 years; n=27) undergoing serial CMR studies from two tertiary medical centers were evaluated. The median time interval between initial and follow-up CMR scans was 3.7 years. LGE was semiautomatically quantified by measuring regions with signal intensity >6 SD above the nulled remote myocardium and manually adjusting a grayscale threshold. Results: LGE was identified at baseline in 61 of the 102 HCM patients (60%), occupying 4.8 ± 3.9% of the left ventricular (LV) mass. At the end of the follow-up period, 53 of the 61 patients (87%) demonstrated an increase in the extent of LGE to 7.7 ± 5.4%, and 8 patients had no change. In 5 patients (5%), LGE increased to extensive with >15% of the LV mass. The rate of LGE progression was 0.7 ± 1.0%/year, including 21 patients (21%) with particularly accelerated progression of ≥1%/year. The risk of LGE progression ≥1%/year was significantly higher in patients <60 years than those ≥ 60 years (25% vs. 7%, p=0.03). The odds of LGE progression ≥1%/year was almost 4 times greater for patients <60 years compared with those ≥ 60 years (odds ratio, 4.2; 95%CI, 1.1-27.9). Age <60 years and LGE extent ≥ 10% were significant baseline predictors for future LGE progression ≥1%/year, even after adjustment for other potential risk factors. Conclusion: In HCM, progressive fibrosis occurs more frequently in young to middle-aged patients, underscoring the importance of repeating CMR to re-evaluate for potential LGE progression in this age group. |
| format | Article |
| id | doaj-art-4597a5cdcd7a4d74b1fe39f0c1fec5c5 |
| institution | OA Journals |
| issn | 1097-6647 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj-art-4597a5cdcd7a4d74b1fe39f0c1fec5c52025-08-20T02:35:40ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472024-01-0126210107210.1016/j.jocmr.2024.101072Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathyShiro Nakamori0Ethan J. Rowin1Jennifer Rodriguez2Long H. Ngo3Warren J. Manning4Martin Maron5Reza Nezafat6Departments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, JapanHypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USADepartments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USADepartments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USADepartments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Departments of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USAHypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USADepartments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Corresponding author. Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA.ABSTRACT: Background: The extent of late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM) is associated with an increased risk of sudden cardiac death events. However, the clinical significance of age-specific longitudinal changes in LGE is not well characterized in HCM. We sought to assess whether the risk of LGE progression diverges between young to middle-aged (ages 20-59 years) and older (≥ 60) adults with HCM. Methods: A total of 102 HCM patients (age <60 years; n=75, age ≥60 years; n=27) undergoing serial CMR studies from two tertiary medical centers were evaluated. The median time interval between initial and follow-up CMR scans was 3.7 years. LGE was semiautomatically quantified by measuring regions with signal intensity >6 SD above the nulled remote myocardium and manually adjusting a grayscale threshold. Results: LGE was identified at baseline in 61 of the 102 HCM patients (60%), occupying 4.8 ± 3.9% of the left ventricular (LV) mass. At the end of the follow-up period, 53 of the 61 patients (87%) demonstrated an increase in the extent of LGE to 7.7 ± 5.4%, and 8 patients had no change. In 5 patients (5%), LGE increased to extensive with >15% of the LV mass. The rate of LGE progression was 0.7 ± 1.0%/year, including 21 patients (21%) with particularly accelerated progression of ≥1%/year. The risk of LGE progression ≥1%/year was significantly higher in patients <60 years than those ≥ 60 years (25% vs. 7%, p=0.03). The odds of LGE progression ≥1%/year was almost 4 times greater for patients <60 years compared with those ≥ 60 years (odds ratio, 4.2; 95%CI, 1.1-27.9). Age <60 years and LGE extent ≥ 10% were significant baseline predictors for future LGE progression ≥1%/year, even after adjustment for other potential risk factors. Conclusion: In HCM, progressive fibrosis occurs more frequently in young to middle-aged patients, underscoring the importance of repeating CMR to re-evaluate for potential LGE progression in this age group.http://www.sciencedirect.com/science/article/pii/S1097664724010998AgeCardiovascular magnetic resonanceHypertrophic cardiomyopathyLate gadolinium enhancementProgressive fibrosis |
| spellingShingle | Shiro Nakamori Ethan J. Rowin Jennifer Rodriguez Long H. Ngo Warren J. Manning Martin Maron Reza Nezafat Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathy Journal of Cardiovascular Magnetic Resonance Age Cardiovascular magnetic resonance Hypertrophic cardiomyopathy Late gadolinium enhancement Progressive fibrosis |
| title | Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathy |
| title_full | Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathy |
| title_fullStr | Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathy |
| title_full_unstemmed | Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathy |
| title_short | Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathy |
| title_sort | accelerated myocardial fibrosis in young to middle aged patients with hypertrophic cardiomyopathy |
| topic | Age Cardiovascular magnetic resonance Hypertrophic cardiomyopathy Late gadolinium enhancement Progressive fibrosis |
| url | http://www.sciencedirect.com/science/article/pii/S1097664724010998 |
| work_keys_str_mv | AT shironakamori acceleratedmyocardialfibrosisinyoungtomiddleagedpatientswithhypertrophiccardiomyopathy AT ethanjrowin acceleratedmyocardialfibrosisinyoungtomiddleagedpatientswithhypertrophiccardiomyopathy AT jenniferrodriguez acceleratedmyocardialfibrosisinyoungtomiddleagedpatientswithhypertrophiccardiomyopathy AT longhngo acceleratedmyocardialfibrosisinyoungtomiddleagedpatientswithhypertrophiccardiomyopathy AT warrenjmanning acceleratedmyocardialfibrosisinyoungtomiddleagedpatientswithhypertrophiccardiomyopathy AT martinmaron acceleratedmyocardialfibrosisinyoungtomiddleagedpatientswithhypertrophiccardiomyopathy AT rezanezafat acceleratedmyocardialfibrosisinyoungtomiddleagedpatientswithhypertrophiccardiomyopathy |