Feature Tracking–Derived Global Longitudinal Strain Enhances Risk Stratification for Sudden Cardiac Death in Hypertrophic Cardiomyopathy (JIMG January 2026)-Article: Feature Tracking–Derived Global Longitudinal Strain Enhances Risk Stratification for Sudden Cardiac Death in Hypertrophic Cardiomyopathy

Article: Feature Tracking–Derived Global Longitudinal Strain Enhances Risk Stratification for Sudden Cardiac Death in Hypertrophic Cardiomyopathy

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This study investigated the prognostic value of left ventricular global longitudinal strain (LV-GLS), measured by cardiac magnetic resonance (CMR) feature tracking, in predicting sudden cardiac death (SCD) risk among patients with hypertrophic cardiomyopathy (HCM). Researchers retrospectively analyzed 2,009 HCM patients (mean age 50 years, 70% male) who underwent CMR between 2010-2017, over a median follow-up of 7.4 years. The primary endpoint was SCD and aborted SCD events.<br /><br />Key findings include that patients experiencing SCD events (4.2%) had significantly reduced absolute LV-GLS values versus those without events (9.0% ± 3.6% vs 11.1% ± 3.6%, p<0.001). LV-GLS independently predicted SCD risk after adjustment for existing risk models by the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA). Adding LV-GLS to these guidelines improved the 5-year predictive accuracy (AUC increased from 0.72 to 0.77 for ESC model, and 0.71 to 0.76 for ACC/AHA model). An LV-GLS cutoff of 9.23% further refined risk stratification, including in patients categorized as low-risk or not recommended for implantable cardioverter-defibrillator (ICD) by current guidelines.<br /><br />Mediation analysis showed LV-GLS partially mediated (17.5-23.1%) the relationship between myocardial abnormalities—maximum wall thickness and extent of late gadolinium enhancement (fibrosis)—and SCD risk, suggesting LV-GLS represents a mechanistic link between myocardial structural changes and arrhythmic events.<br /><br />The study supports LV-GLS measured by CMR as a sensitive marker detecting subtle myocardial dysfunction beyond traditional metrics like left ventricular ejection fraction and fibrosis extent. Its incorporation into clinical risk models may enhance personalized SCD risk stratification and guide ICD therapy decisions in HCM patients. Limitations include retrospective single-center design, exclusion of patients with septal reduction therapy, and lack of certain genetic or exercise data. Prospective multicenter studies are warranted to validate these findings and define clinical implementation.<br /><br />In conclusion, CMR-derived LV-GLS provides incremental and mechanistic prognostic value for SCD risk in HCM and may improve individualized management strategies.

Keywords

left ventricular global longitudinal strain

LV-GLS

cardiac magnetic resonance

CMR feature tracking

sudden cardiac death

SCD risk prediction

hypertrophic cardiomyopathy

HCM risk stratification

implantable cardioverter-defibrillator

myocardial fibrosis