Myocardial scar is a common finding in patients with hypertrophic cardiomyopathy (HCM) and provides the substrate for ventricular arrhythmia (VA). Contrast-enhanced cardiac magnetic resonance (ce-CMR) allows accurate identification and quantification of myocardial scar tissue and enables to differentiate between the scar core and border zone (BZ). Of note, novel imaging techniques are available that isolate channels of healthy myocardial tissue in the context of the BZ that connect areas of normal myocardium between core areas. These protected connecting channels represent an essential component of reentry circuits and may be critical to entail VA and sudden cardiac death (SCD) in HCM patients.
This study will test the hypothesis that fine characterization of the scar architecture by ce-CMR may improve risk stratification of VA and SCD in patients with HCM.
The present research proposal will analyze the impact of the presence and characteristics of myocardial scar, assessed by ce-CMR, on the occurrence of appropriate ICD therapies in hypertrophic cardiomyopathy patients. Specifically, the extension and heterogeneity of the myocardial scar, as well as the optimal cutoff value for the scar mass to predict ICD therapies will be assessed. If the presence, extension, heterogeneity, and qualitative distribution of borderzone tissue of myocardial scar will predict appropriate ICD therapies and SCD, algorithms based on scar mass characterization from ce-CMR will help to substantially improve models of prediction of sudden cardiac death in hypertrophic cardiomyopathy patients.
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