OBJECTIVES: We sought to establish the prognostic value of a comprehensive 
cardiovascular magnetic resonance (CMR) examination in risk stratification of 
hypertrophic cardiomyopathy (HCM) patients.
BACKGROUND: With annual mortality rates ranging between 1% and 5%, depending on 
patient selection, a small but significant number of HCM patients are at risk 
for an adverse event. Therefore, the identification of and prophylactic therapy 
(i.e., defibrillator placement) in patients with HCM who are at risk of dying 
are imperative.
METHODS: Two-hundred forty-three consecutive patients with HCM were 
prospectively enrolled. All patients underwent initial CMR, and 220 were 
available for clinical follow-up. The mean follow-up time was 1,090 days after 
CMR. End points were all-cause and cardiac mortality.
RESULTS: During follow-up 20 of the 220 patients died, and 2 patients survived 
sudden cardiac death due to adequate implantable cardioverter-defibrillator 
discharge. Most events (n = 16) occurred for cardiac reasons; the remaining 6 
events were related to cancer and accidents. Our data indicate that the presence 
of scar visualized by CMR yields an odds ratio of 5.47 for all-cause mortality 
and of 8.01 for cardiac mortality. This might be superior to classic clinical 
risk factors, because in our dataset the presence of 2 risk factors yields an 
odds ratio of 3.86 for all-cause and of 2.20 for cardiac mortality, 
respectively. Multivariable analysis also revealed the presence of late 
gadolinium enhancement as a good independent predictor of death in HCM patients.
CONCLUSIONS: Among our population of largely low or asymptomatic HCM patients, 
the presence of scar indicated by CMR is a good independent predictor of 
all-cause and cardiac mortality.