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Comparative Study
. 2021 Mar 30;11(1):7146.
doi: 10.1038/s41598-021-86532-4.

Sudden cardiac death risk in hypertrophic cardiomyopathy: comparison between echocardiography and magnetic resonance imaging

Mateusz Śpiewak  1 , Mariusz Kłopotowski  2 , Ewa Kowalik  3 , Agata Kubik  4 , Natalia Ojrzyńska-Witek  5 , Joanna Petryka-Mazurkiewicz  6 , Ewa Michalak  7 , Łukasz Mazurkiewicz  5 , Monika Gawor  5 , Katarzyna Kożuch  3 , Barbara Miłosz-Wieczorek  4 , Jacek Grzybowski  5 , Zofia Bilińska  7 , Adam Witkowski  2 , Anna Klisiewicz  3 , Magdalena Marczak  4
Affiliations
Comparative Study

Sudden cardiac death risk in hypertrophic cardiomyopathy: comparison between echocardiography and magnetic resonance imaging

Mateusz Śpiewak et al. Sci Rep. .

Abstract

In hypertrophic cardiomyopathy (HCM) patients, left ventricular (LV) maximal wall thickness (MWT) is one of the most important factors determining sudden cardiac death (SCD) risk. In a large unselected sample of HCM patients, we aimed to simulate what changes would occur in the calculated SCD risk according to the European HCM Risk-SCD calculator when MWT measured using echocardiography was changed to MWT measured using MRI. All consecutive patients with HCM who underwent cardiac MRI were included. MWT measured with echocardiography and MRI were compared, and 5-year SCD risk according to the HCM Risk-SCD calculator was computed using four different models. The final population included 673 patients [389 (57.8%) males, median age 50 years, interquartile range (36-60)]. The median MWT was lower measured by echocardiography than by MRI [20 (17-24) mm vs 21 (18-24) mm; p < 0.0001]. There was agreement between echocardiography and MRI in the measurement of maximal LV wall thickness in 96 patients (14.3%). The largest differences between echo and MRI were - 13 mm and + 9 mm. The differences in MWT by echocardiography and MRI translated to a maximal difference of 8.33% in the absolute 5-year risk of SCD, i.e., the echocardiography-based risk was 8.33% lower than the MRI-based estimates. Interestingly, 13.7% of patients would have been reclassified into different SCD risk categories if MRI had been used to measure MWT instead of echocardiography. In conclusion, although there was high general intermodality agreement between echocardiography and MRI in the MWT measurements, the differences in MWT translated to significant differences in the 5-year risk of SCD.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
(A) Magnetic resonance image in short-axis slice demonstrating left ventricular hypertrophy with the maximal left ventricular wall thickness of 32 mm in basal anterior segment, which has been underestimated by 13 mm in transthoracic echocardiography. (B) Magnetic resonance image in short-axis slice demonstrating left ventricular hypertrophy with the maximal left ventricular wall thickness of 20 mm in mid infero-septal segment. The echocardiographic measurement of maximal left ventricular wall thickness (29 mm) was overestimated by inclusion of right ventricular trabeculae adjacent to the mid antero-septal segment.
Figure 2
Figure 2
Bland–Altman plot demonstrating differences between left ventricular maximal wall thickness (LV MWT) by echocardiography and by MRI.
Figure 3
Figure 3
Bland–Altman plot demonstrating differences between echocardiography- and MRI-derived SCD risk estimates according to Model 1 (best clinical scenario).
Figure 4
Figure 4
Bland–Altman plot demonstrating differences between echocardiography- and MRI-derived SCD risk estimates according to Model 2 (FHSCD scenario).
Figure 5
Figure 5
Bland–Altman plot demonstrating differences between echocardiography- and MRI-derived SCD risk estimates according to Model 3 (FHSCD + NSVT scenario).
Figure 6
Figure 6
Bland–Altman plot demonstrating differences between echocardiography- and MRI-derived SCD risk estimates according to Model 4 (worst clinical scenario).
See this image and copyright information in PMC

References

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