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Original research
Cardiovascular magnetic resonance T2* mapping for the assessment of cardiovascular events in hypertrophic cardiomyopathy
  1. Mareike Gastl1,2,3,
  2. Christiane Gruner1,
  3. Karin Labucay1,
  4. Alexander Gotschy1,2,
  5. Jochen Von Spiczak2,4,
  6. Malgorzata Polacin4,
  7. Florian Boenner3,
  8. Malte Kelm3,
  9. Frank Ruschitzka1,
  10. Hatem Alkadhi4,
  11. Sebastian Kozerke2 and
  12. Robert Manka1,2,4
  1. 1Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
  2. 2Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
  3. 3Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Dusseldorf, Germany
  4. 4Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Mareike Gastl; mareike.gastl{at}


Background Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of adverse cardiac events. Beyond classic risk factors, relative myocardial ischaemia and succeeding myocardial alterations, which can be detected using either contrast agents or parametric mapping in cardiovascular magnetic resonance (CMR) imaging, have shown an impact on outcome in HCM. CMR may help to risk stratify using parametric T2* mapping. Therefore, the aim of the present study was to evaluate the association of T2* values or fibrosis with cardiovascular events in HCM.

Methods The relationship between T2* with supraventricular, ventricular arrhythmia or heart failure was retrospectively assessed in 91 patients with HCM referred for CMR on a 1.5T MR imaging system. Fibrosis as a reference was added to the model. Patients were subdivided into groups according to T2* value quartiles.

Results 47 patients experienced an event of ventricular arrhythmia, 25 of atrial fibrillation/flutter and 17 of heart failure. T2*≤28.7 ms yielded no association with ventricular events in the whole HCM cohort. T2* of non-obstructive HCM showed a significant association with ventricular events in univariate analysis, but not in multivariate analysis. For the combined endpoint of arrhythmic events, there was already an association for the whole HCM cohort, but again only in univariate analyses. Fibrosis stayed the strongest predictor in all analyses. There was no association for T2* and fibrosis with heart failure.

Conclusions Decreased T2* values by CMR only provide a small association with arrhythmic events in HCM, especially in non-obstructive HCM. No information is added for heart failure.

  • MRI
  • ventricular hypertrophy
  • myocardial ischaemia and infarction (IHD)
  • myocardial fibrosis
  • arrhythmias

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  • Contributors MG, AG, JVS, MP: acquired the CMR data. MG: performed statistical analyses. CG, KL: contributed in statistical analyses. MG and RM: wrote the main manuscript. CG, KL, AG, JVS, MP, FB, MK, FR, HA, SK: contributed in discussions. All authors reviewed the manuscript.

  • Funding This work was supported by a grant from the German Research Foundation (DFG) Research Fellowship (GA 2621/1-1).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Written informed consent was waived by the Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data used in this manuscript can be made available upon reasonable request from the first or last author. If made available, data will be deidentified.

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