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Impact of Novel Maximal Wall Thickness Adjustments on Arrhythmic Event Prediction in Hypertrophic Cardiomyopathy
Session:
SESSÃO DE POSTERS 19 - IMAGEM NAS MIOCARDIOPATIAS
Speaker:
Rita Amador
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Resonance
Session Type:
Cartazes
FP Number:
---
Authors:
Rita Amador; Rita Carvalho; Pedro Freitas; Rita Lima; Pedro Lopes; Franscisco Gama; Sara Guerreiro; Edmundo Arteaga; Pedro Carmo; Pedro Adragão; Carlos Rochite; António Ferreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background: </strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">A recent study from the UK Biobank proposed individualized maximal wall thickness (MWT) thresholds (adjusted for age, sex, and body surface area) to replace the classic 15mm criterion and improve diagnostic accuracy in patients with suspected hypertrophic cardiomyopathy (HCM). Our study aimed to assess whether this novel approach can also strengthen the association between MWT and arrhythmic events in patients with established HCM. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We conducted a multicenter international retrospective analysis of HCM patients who underwent cardiac magnetic resonance (CMR) for diagnostic confirmation and risk stratification. MWT was measured using both echocardiography and CMR. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">For each patient, the individualized upper limit of normal (ULN) for MWT was calculated and compared with the measured MWT using two different metrics: absolute excess hypertrophy (measured – ULN) and relative excess hypertrophy (measured / ULN). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The primary composite endpoint included SCD, appropriate implantable cardioverter-defibrillator (ICD) discharges, and sustained ventricular tachycardia (VT). The secondary endpoint was the presence of non-sustained VT on Holter monitoring.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong><br /> A total of 530 HCM patients (mean age 49 ± 17 years; 44% male) were included. Mean MWT was 20 ± 5 mm on transthoracic echocardiography and 21 ± 5 mm on CMR, with a theoretical individualized ULN of 13 mm (IQR 12–14 mm). Clinical risk factors included a family history of SCD (13%), unexplained syncope (12%), and NSVT (19%). Over a median follow-up of 50 months, 28 patients experienced a primary endpoint event (15 SCDs, 6 ICD discharges, and 7 sustained VTs).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">No significant differences in MWT were observed between patients with and without primary endpoint events. Similarly, neither absolute nor relative excess hypertrophy improved predictive value for SCD-related outcomes. For NSVT, significant differences in MWT, absolute, and relative excess hypertrophy were noted. However, hypertrophy indexing methods showed no advantage over raw MWT measurements in prognostic performance (Wald 9 vs. 13, respectively).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusions:</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">In this cohort, novel adjustments to MWT values, including indexing to body surface area and the use of predicted MWT thresholds, did not improve the prediction of SCD-related events or appropriate device therapies. These findings suggest limited utility for these methods in HCM risk stratification.</span></span></p>
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