ScholarWorks@성균관대학교

초록

Background Late gadolinium enhancement (LGE) and left ventricular global longitudinal strain (LV-GLS) are structural and functional left ventricular remodeling markers in hypertrophic cardiomyopathy (HCM). Objectives This study investigated the prognostic value of integrating both markers for risk stratification in HCM. Methods Consecutive patients with HCM who underwent CMR between 2008 and 2020 at 2 tertiary hospitals were retrospectively analyzed. LGE% and LV-GLS were measured, with LV-GLS reported as an absolute value. The primary outcome was cardiovascular (CV) events: CV death, sudden cardiac death–related events, and heart failure hospitalization. Results Among 652 patients with HCM (median age 56 years; 74% [481 of 652] male), median LGE% and LV-GLS were 4.2% and 14.3%, respectively. During the median 7.4-year follow-up (Q1-Q3: 3.4-10.3 years), 59 patients (9.0%) experienced CV events. Higher LGE% and lower LV-GLS were associated with increased CV events (per 1% LGE% increase, adjusted HR [aHR]: 1.04 [95% CI: 1.01-1.06; P = 0.005]; per 1% LV-GLS decrease, aHR: 1.08 [95% CI 1.00-1.15; P = 0.038]). When analyzing the 4 groups stratified according to LGE% and LV-GLS, patients with both high LGE% (>4.2%) and low LV-GLS (<14.3%) had the highest incidence of CV events (aHR: 2.88; 95% CI: 1.21-6.85; P = 0.017). Mediation analysis showed a significant indirect effect of LGE% on CV events through LV-GLS. Sudden cardiac death–related events were most frequent in patients with both high LGE and low LV-GLS. Conclusions LGE and LV-GLS provide complementary prognostic information in HCM. Patients with both increased LGE and decreased LV-GLS are at particularly high risk, highlighting the value of integrating both biomarkers for risk stratification.

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