Additional prognostic values of strain and strain rate over late gadolinium enhancement in hypertrophic cardiomyopathy patients

Published:November 01, 2022DOI:


      • Peak systolic-global longitudinal strain rate was independently associated with major adverse cardiovascular events.
      • Patients with peak systolic-global longitudinal strain rate ≥ −0.49 s−1 had significantly better survival than patients with peak systolic-global longitudinal strain rate < −0.49 s−1.
      • The model constructed by conventional variables plus peak systolic-global longitudinal strain rate had significantly stronger predictive ability than the model constructed by conventional variables plus late gadolinium enhancement/left ventricular mass.



      Late gadolinium enhancement (LGE) has some shortcomings in the risk stratification in hypertrophic cardiomyopathy (HCM). Myocardial strain/strain rate (SR) can be acquired from unenhanced cardiovascular magnetic resonance (CMR) images and detect cardiac dysfunction sensitively. The present study aimed to evaluate the additional prognostic values of myocardial strain/SR beyond LGE for the risk stratification in patients with HCM.


      293 patients with HCM who underwent CMR were enrolled in this prospective study. LGE/left ventricular (LV) mass, LV global strain, and SR were acquired based on CMR. Also, conventional clinical, echocardiography, and CMR parameters and established risk factors for HCM were evaluated.


      14/293 patients had major adverse cardiovascular events (MACEs) during the median follow-up of 15.0 months, including eight all-cause deaths, four resuscitated cardiac arrests and two cardiac transplantations. Peak systolic (PS)-global longitudinal SR (GLSR) was independently associated with MACEs (hazard ratio: 15.297, P < 0.001) after adjusting for conventional clinical characteristics, echocardiography, and CMR parameters. The model constructed by conventional variables plus PS-GLSR had significantly stronger predictive ability than the model constructed by conventional variables plus LGE/LV mass (C-statistic: 0.850 vs 0.708, P = 0.030). The addition of PS-GLSR to the conventional model also significantly improved the sensitivity (92.9% vs 71.4%) and specificity (71.0% vs 57.3%), and lowered false positives (81 patients vs 119 patients) compared to the addition of LGE/LV mass.


      LV PS-GLSR derived from CMR has the potential to be a novel biomarker for risk stratification of HCM and provide additional prognostic value over LGE/LV mass.



      HCM (hypertrophic cardiomyopathy), SCD (sudden cardiac death), ESC (European Society of Cardiology), ACC/AHA (American College of Cardiology/American Heart Association), ICD (implantable cardioverter-defibrillator), LGE (late gadolinium enhancement), CMR (cardiac magnetic resonance), LV (left ventricular), GBCA (gadolinium-based contrast agent), SR (strain rate), LVEF (left ventricular ejection fraction), GLS (global longitudinal strain), LVWT (left ventricular wall thickness), LVOT (left ventricular outflow tract), PS (peak systolic), GRS (global radial strain), GCS (global circumferential strain), GRSR (global radial strain rate), GCSR (global circumferential strain rate), GLSR (global longitudinal strain rate), PD (peak diastolic), NSVT (non-sustained ventricular tachycardia), MACEs (major adverse cardiovascular events), IQR (interquartile range), ICC (intraclass correlation coefficient), AUC (area under the curve), HR (hazard ratio), CI (confidence interval)
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