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Maximal Wall Thickness Measurement in Hypertrophic Cardiomyopathy

Authors :
Rina Ariga
Petros Nihoyannopoulos
Elizabeth Ormondroyd
Aslan T. Turer
Perry M. Elliott
João B. Augutsto
Gabriella Captur
Rhodri H. Davies
Savvas Loizos
Charlotte Manisty
Alan G. Fraser
Diego Perez de Arenaza
Mark Westwood
Ilaria Lobascio
Andrew J. Taylor
Steffen E. Petersen
Claudia Camaioni
Timothy C. Wong
Vlad G. Zaha
Mouaz H. Al-Mallah
Betty Raman
Iacopo Olivotto
Arthur Nasis
Alberto Marchi
Shiro Nakamori
Hugh Watkins
Raymond Y. Kwong
Vimal Patel
Carolyn Y. Ho
Stefan Neubauer
Anish N Bhuva
Reza Nezafat
Lijun Tang
Guy Lloyd
Jenade Bonsu-Ofori
Chunming Li
Sinitsyn Valentin
James C. Moon
Source :
JACC: Cardiovascular Imaging. 14:2123-2134
Publication Year :
2021
Publisher :
Elsevier BV, 2021.

Abstract

Objectives\udThe aim of this study was to define the variability of maximal wall thickness (MWT) measurements across modalities and predict its impact on care in patients with hypertrophic cardiomyopathy (HCM).\ud\udBackground\udLeft ventricular MWT measured by echocardiography or cardiovascular magnetic resonance (CMR) contributes to the diagnosis of HCM, stratifies risk, and guides key decisions, including whether to place an implantable cardioverter-defibrillator (ICD).\ud\udMethods\udA 20-center global network provided paired echocardiographic and CMR data sets from patients with HCM, from which 17 paired data sets of the highest quality were selected. These were presented as 7 randomly ordered pairs (at 6 cardiac conferences) to experienced readers who report HCM imaging in their daily practice, and their MWT caliper measurements were captured. The impact of measurement variability on ICD insertion decisions was estimated in 769 separately recruited multicenter patients with HCM using the European Society of Cardiology algorithm for 5-year risk for sudden cardiac death.\ud\udResults\udMWT analysis was completed by 70 readers (from 6 continents; 91% with >5 years’ experience). Seventy-nine percent and 68% scored echocardiographic and CMR image quality as excellent. For both modalities (echocardiographic and then CMR results), intramodality inter-reader MWT percentage variability was large (range –59% to 117% [SD ±20%] and –61% to 52% [SD ±11%], respectively). Agreement between modalities was low (SE of measurement 4.8 mm; 95% CI 4.3 mm-5.2 mm; r = 0.56 [modest correlation]). In the multicenter HCM cohort, this estimated echocardiographic MWT percentage variability (±20%) applied to the European Society of Cardiology algorithm reclassified risk in 19.5% of patients, which would have led to inappropriate ICD decision making in 1 in 7 patients with HCM (8.7% would have had ICD placement recommended despite potential low risk, and 6.8% would not have had ICD placement recommended despite intermediate or high risk).\ud\udConclusions\udUsing the best available images and experienced readers, MWT as a biomarker in HCM has a high degree of inter-reader variability and should be applied with caution as part of decision making for ICD insertion. Better standardization efforts in HCM recommendations by current governing societies are needed to improve clinical decision making in patients with HCM.

Details

ISSN :
1936878X
Volume :
14
Database :
OpenAIRE
Journal :
JACC: Cardiovascular Imaging
Accession number :
edsair.doi.dedup.....851bd05600cf2d048351cce9106a7af8
Full Text :
https://doi.org/10.1016/j.jcmg.2021.03.032