Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance

Adabag, A. Selcuk; Maron, Barry J.; Appelbaum, Evan; Harrigan, Caitlin J.; Buros, Jacqueline L.; Gibson, C. Michael; Lesser, John R.; Hanna, Constance A.; Udelson, James E.; Manning, Warren J.; Maron, Martin S.

doi:10.1016/j.jacc.2007.11.071

Cited by 662Cardiomyopathy and Myosin StudiesCardiovascular Effects of ExerciseCardiac electrophysiology and arrhythmias

Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance

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Adabag, A. Selcuk, Maron, Barry J., Appelbaum, Evan, Harrigan, Caitlin J., Buros, Jacqueline L., Gibson, C. Michael, Lesser, John R., Hanna, Constance A. +3 more·2008·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2007.11.071

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Abstract

Objectives Our aim was to determine whether myocardial fibrosis, detected by cardiovascular magnetic resonance (CMR), represents an arrhythmogenic substrate in hypertrophic cardiomyopathy (HCM).Background Myocardial fibrosis is identified frequently in HCM; however, the clinical significance of this finding is uncertain.Methods We studied prevalence and frequency of tachyarrhythmias on 24-h ambulatory Holter electrocardiogram (ECG) with regard to delayed enhancement (DE) on contrast-enhanced CMR in 177 HCM patients (age 41 +/- 16 yrs; 95% asymptomatic or mildly symptomatic).Results Premature ventricular contractions (PVCs), couplets, and nonsustained ventricular tachycardia (NSVT) were more common in patients with DE than those without DE (PVCs: 89% vs. 72%; couplets: 40% vs. 17%; NSVT: 28% vs. 4%; p < 0.0001 to 0.007). Patients with DE also had greater numbers of PVCs (202 +/- 655 vs. 116 +/- 435), couplets (1.9 +/- 5 vs. 1.2 +/- 10), and NSVT runs (0.4 +/- 0.8 vs. 0.06 +/- 0.4) than non-DE patients (all p < 0.0001); DE was an independent predictor of NSVT (relative risk 7.3, 95% confidence interval 2.6 to 20.4; p < 0.0001). However, extent (%) of DE was similar in patients with and without PVCs (8.2% vs. 9.1%; p = 0.93), couplets (8.5% vs. 8.4%; p = 0.99), or NSVT (8.3% vs. 8.5%; p = 0.35).Conclusions In this large HCM cohort with no or only mild symptoms, myocardial fibrosis detected by CMR was associated with greater likelihood and increased frequency of ventricular tachyarrhythmias (including NSVT) on ambulatory Holter ECG. Therefore, contrast-enhanced CMR identifies HCM patients with increased susceptibility to ventricular tachyarrhythmias.

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The frequency of NSVT in HCM is related to the degree of myocardial fibrosis.
“The frequency is related to the degree of myocardial fibrosis”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Adabag et al., 2008
The Abstract and Patient characteristics section report more NSVT runs in HCM patients with CMR-detected fibrosis than in those without it. But the Abstract says the extent of delayed enhancement was similar in patients with and without NSVT (8.3% versus 8.5%; p = 0.35), so the paper supports a relationship with the presence of fibrosis, not its degree. (LLM, conf=0.87)
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[21]21. Moon JC, McKenna WJ, McCrohon JA, Elliott PM, Smith GC, Pennell DJ. Toward clinical risk assessment in hypertrophic cardio- myopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol 2003;41:1561-7.

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Authors: Adabag, A. S., Maron, B. J., Appelbaum, E., Harrigan, C. J., Buros, J. L., Gibson, C. M., Lesser, J. R., Hanna, C. A., Udelson, J. E., Manning, W. J., & Maron, M. S.
Affiliations: Minneapolis Heart Institute Foundation (US)
Beth Israel Deaconess Medical Center (US)
Harvard University (US)
Tufts Medical Center (US)
ORCID: Maron, Barry J.
Buros, Jacqueline L.
Gibson, C. Michael
Lesser, John R.
Udelson, James E.
Manning, Warren J.
Maron, Martin S.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2008-04
Volume: 51
Issue: 14
Pages: 1369-1374
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2007.11.071
OpenAlex: W2076526672
Cited by: 662
References: 43
Citations by year: 2026: 10 · 2025: 12 · 2024: 12 · 2023: 14 · 2022: 15 · 2021: 24 · 2020: 24 · 2019: 28 · 2018: 32 · 2017: 29 · 2016: 39 · 2015: 42 · 2014: 64 · 2013: 48 · 2012: 60
FWCI: 50.64
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1932 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Funders: Clinical Science Research and Development
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords: hypertrophic cardiomyopathy, myocardial fibrosis, late gadolinium enhancement, cardiovascular magnetic resonance, ventricular arrhythmias, non-sustained ventricular tachycardia, premature ventricular contractions, arrhythmogenic substrate, Holter monitoring, asymptomatic patients, arrhythmic risk stratification, contrast-enhanced MRI, cardiac resynchronization therapy, implantable cardioverter-defibrillator
MeSH terms: Adolescent, Adult, Aged, Cardiomyopathy, Hypertrophic, Female, Fibrosis, Health Status Indicators, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Prospective Studies, Tachycardia, Time Factors, Prevalence, Risk Assessment, Blood Pressure Monitoring, Ambulatory, Ventricular Premature Complexes

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Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance

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