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Occurrence and Frequency of Arrhythmias in Hypertrophic Cardiomyopathy in Relation to Delayed Enhancement on Cardiovascular Magnetic Resonance
Open accessAbstract
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 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
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Metadata
- 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
- 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)
- 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
- 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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