Serial Myocardial Fibrosis Assessments Predict Outcomes in Patients With Hypertrophic Cardiomyopathy (JIMG June 2026)-Article: Serial Myocardial Fibrosis Assessments Predict Outcomes in Patients With Hypertrophic Cardiomyopathy

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This retrospective study examined whether changes in myocardial fibrosis over time, measured by serial cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE), predict outcomes in hypertrophic cardiomyopathy (HCM).<br /><br />Researchers analyzed 313 HCM patients who had two CMR scans about 4.2 years apart, then followed them for a median of 3.4 years after the second scan. LGE, a marker of replacement fibrosis, increased substantially over time: median LGE mass rose from 2.9 g to 8.3 g, and the proportion of patients with extensive LGE (≥15% of left ventricular mass) increased from 6.7% to 14.7%. Nearly 70% of patients with no LGE on the first scan developed new fibrosis by follow-up.<br /><br />The main outcome was a composite of death, heart transplantation, aborted sudden cardiac death, heart failure hospitalization, and stroke. Using statistical cutpoint analysis, the study found that an annual LGE mass increase of 1.50 g/year best predicted the primary endpoint, while 3.75 g/year best predicted the harder secondary endpoint. After adjustment, ΔLGE mass/year ≥1.50 g/year independently doubled the risk of the primary endpoint (HR 2.22). Adding LGE progression to a model based on conventional risk factors improved prediction and risk reclassification.<br /><br />An external validation cohort of 69 patients from six other hospitals confirmed the prognostic value of the 1.50 g/year cutoff.<br /><br />The authors conclude that myocardial fibrosis in HCM is dynamic and that serial CMR assessment of LGE progression can improve risk stratification beyond single-time-point imaging. This may help guide follow-up frequency and treatment decisions, including consideration of preventive interventions in higher-risk patients.

Meta Tag

Concept Cardiovascular Magnetic Resonance

Concept Myocardial Fibrosis

Concept Hypertrophic Cardiomyopathy

Concept Late Gadolinium Enhancement

Concept Sudden Cardiac Death

Keywords

hypertrophic cardiomyopathy

myocardial fibrosis

cardiac magnetic resonance

late gadolinium enhancement

LGE progression

risk stratification

sudden cardiac death

heart failure hospitalization

replacement fibrosis

prognostic outcomes

Cardiovascular Magnetic Resonance

Myocardial Fibrosis

Hypertrophic Cardiomyopathy

Late Gadolinium Enhancement

Sudden Cardiac Death