Serial Myocardial Fibrosis Assessments Predict Outcomes in Patients with Hypertrophic Cardiomyopathy: A Cardiac Magnetic Resonance Study

Motivation: In the 2020 AHA/ACC guideline for patients with hypertrophic cardiomyopathy (HCM), repeat contrast-enhanced cardiac magnetic resonance (CMR) is recommended to evaluate late gadolinium enhancement (LGE) changes every 3-5 years for risk stratification. Goal(s): To investigate the prognostic value of LGE assessed by serial CMR in HCM patients. Approach: 313 consecutive patients with HCM who underwent two CMRs with long-term follow-up were retrospectively included. Results: On the MaxStat analysis for primary and secondary endpoints, the optimal prognostic cut point was >1.50 and 3.75g/year, respectively. LGE mass progression was independently associated with the outcome and further improve the risk stratification. Impact: In patients with hypertrophic cardiomyopathy, myocardial fibrosis increases over time. Judicious and serial assessments of late gadolinium enhancement on cardiac magnetic resonance can improve risk stratification and clinical decision-making to help patient management.