Cardiac Magnetic Resonance-Derived Left Ventricular Mechanical Dispersion Improves Risk Stratification of Hypertrophic Cardiomyopathy and its Correlations with Scar Heterogeneity.

Abstract

The accuracy of prevalent risk models recommended by American Heart Association/American College of Cardiology(AHA/ACC) and European Society of Cardiology(ESC) for hypertrophic cardiomyopathy(HCM) patients is suboptimal. We assessed the utility of cardiac magnetic resonance(CMR)-3D left ventricular mechanical dispersion(LVMD) in the prognostic stratification of 159 HCM and explore the correlation with myocardial fibrosis heterogeneity. Entropy demonstrated linear correlations with 3D LVMD. Patients experienced endpoint events exhibited significantly higher radial LVMD(LVMD-R), circumferential LVMD(LVMD-C), and longitudinal LVMD(LVMD-L). Kaplan-Meier analyses demonstrated that HCM patients with elevated LVMD had a higher risk of primary and secondary endpoint events. In multivariable Cox analysis incorporated the guidelines risk classification, both LVMD-C and LVMD-L emerged as significant predictors for endpoint events. We developed a model incorporated the 2022 ESC risk stratification in combination with LVMD-C and LVMD-L and revealed that combined model significantly outperformed the guidelines alone. Additionally, entropy demonstrated linear correlations with LVMD.