CORRESPONDENCE: LETTER TO THE EDITOR
Delayed Hyperenhancement Magnetic Resonance Imaging for Sudden Cardiac Death Risk Stratification in Hypertrophic Cardiomyopathy
Georgios K. Efthimiadis and
Efstathios D. Pagourelias*
* Cardiomyopathies Laboratory, First Cardiology Department, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Stilp. Kyriakidi 1, Thessaloniki 54636, Greece (Email: statpag{at}yahoo.gr).
We have read with great interest the consensus guidelines introduced by Goldberger et al. (1) concerning the evaluation of noninvasive risk stratification techniques for identification of patients at risk for sudden cardiac death (SCD). Concerning hypertrophic cardiomyopathy (HCM), the authors conclusively support that the use of electrocardiography, signal-averaged electrocardiography, treadmill exercise test, and 2-dimensional echocardiography, along with obtaining a detailed personal and familial history, can successfully assess risk for SCD, even though no randomized trials exist using these parameters (1).
SCD among HCM patients is mainly connected to the occurrence of ventricular tachycardia/ventricular fibrillation (VT/VF) (2). Many studies suggest that the extent of myocardial disarray-fibrosis, predisposing to re-entry phenomena as part of a general arrhythmogenic tendency, constitutes the main stimulus for VT/VF incidence (3,4). Delayed hyperenhancement magnetic resonance imaging (MRI) accurately detects myocardial fibrosis degree, and a statistically powerful correlation between fibrosis extent and incidence of VT/VF in HCM seems to have been established by previous studies (5,6). However, the role of delayed hyperenhancement MRI as well as its diagnostic and prognostic utility in assessment of SCD risk are not discussed in this consensus document. Obviously, more cohort studies are needed to establish an etiological relationship between scar size and the possibility of sudden death. Notwithstanding, delayed hyperenhancement MRI along with the aforementioned "screening" practices could offer a more precise estimation of risk for SCD in HCM patients.
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1. Goldberger JJ, Cain ME, Hohnloser SH, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention J Am Coll Cardiol 2008;52:1179-1199.[Free Full Text]2. Maron BJ, Shen WK, Link MS, et al. Efficacy of implantable cardioverter- defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy N Engl J Med 2000;342:365-373.[CrossRef][Web of Science][Medline] 3. Varnava AM, Elliott PM, Mahon N, Davies MJ, McKenna WJ. Relation between myocyte disarray and outcome in hypertrophic cardiomyopathy Am J Cardiol 2001;88:275-279.[CrossRef][Web of Science][Medline] 4. Choudhury L, Mahrholdt H, Wagner A, et al. Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy J Am Coll Cardiol 2002;40:2156-2164.[Abstract/Free Full Text] 5. Kwon DH, Setser RM, Popovic ZB, et al. Association of myocardial fibrosis, electrocardiography and ventricular tachyarrhythmia in hypertrophic cardiomyopathy: a delayed contrast enhanced MRI study Int J Cardiovasc Imaging 2008;24:617-625.[CrossRef][Web of Science][Medline] 6. Adabag AS, Maron BJ, Appelbaum E, et al. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance J Am Coll Cardiol 2008;51:1369-1374.[Abstract/Free Full Text]
Related Article
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American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention
- Jeffrey J. Goldberger, Michael E. Cain, Stefan H. Hohnloser, Alan H. Kadish, Bradley P. Knight, Michael S. Lauer, Barry J. Maron, Richard L. Page, Rod S. Passman, David Siscovick, William G. Stevenson, and Douglas P. Zipes
J. Am. Coll. Cardiol. 2008 52: 1179-1199.
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