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Extensive LGE as a novel imaging marker identifying patients with HCM at risk of sudden cardiac death; the importance of quantifying the extent of LGE

Raymond Chan et al have studied the prognostic value of quantitative contrast-enhanced CMR for the evaluation of sudden cardiac death (SCD) risk in patients with hypertrophic cardiomyopathy. In a large cohort of 1293 patients from various centers, late gadolinium enhancement (LGE) was quantified with QMass MR analytical software using a well validated visual thresholding approach. A continuous relationship between LGE by percent LV mass and sudden cardiac death event risk in HCM patients was found. They conclude that extensive LGE measured by quantitative contrast enhanced CMR provides additional information for assessing SCD event risk among HCM patients. There is a clinical perspective according to the authors: “…Extensive LGE may help identify patients at increased risk for SCD events who otherwise would not be considered high risk on the basis of conventional risk stratification strategy and who may become candidates for primary prevention of SCD with an implantable defibrillator. The absence of LGE is associated with low risk, providing a measure of reassurance for patients.”, The time required to do the quantitative analysis averaged 10 minutes per study. For further reading and a video of the visual LGE quantitation method: Circulation 2014; 130: 484-495