Pub Date : 2026-01-05DOI: 10.1016/j.jcmg.2025.12.004
Paul A. Grayburn
{"title":"Impaired Right Ventricular Function After Transcatheter Treatment of Tricuspid Regurgitation","authors":"Paul A. Grayburn","doi":"10.1016/j.jcmg.2025.12.004","DOIUrl":"https://doi.org/10.1016/j.jcmg.2025.12.004","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"98 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jcmg.2025.07.003
Sarah Malik MD , Doosup Shin MD , Emma Caron BSc, Rick H.J.A. Volleberg MD, Koshiro Sakai MD, PhD, Carlos Collet MD, PhD, Evan Shlofmitz DO, Allen Jeremias MD, MSc, Ziad A. Ali MD, DPhil , Omar K. Khalique MD
{"title":"Validation of Coronary Stent Measurements Using Photon-Counting Detector Computed Tomography","authors":"Sarah Malik MD , Doosup Shin MD , Emma Caron BSc, Rick H.J.A. Volleberg MD, Koshiro Sakai MD, PhD, Carlos Collet MD, PhD, Evan Shlofmitz DO, Allen Jeremias MD, MSc, Ziad A. Ali MD, DPhil , Omar K. Khalique MD","doi":"10.1016/j.jcmg.2025.07.003","DOIUrl":"10.1016/j.jcmg.2025.07.003","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 1","pages":"Pages 126-129"},"PeriodicalIF":15.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronary computed tomography angiography (CTA)-derived plaque burden is associated with the risk of cardiovascular events and is expected to be used in clinical practice. Understanding the normative values of computed tomography–based quantitative plaque volume in the general population is clinically important for determining patient management.
Objectives
This study aimed to investigate the distribution of plaque volume in the general population and to develop nomograms using MiHEART (Miami Heart Study) at Baptist Health South Florida, a large community-based cohort study.
Methods
The study included 2,301 asymptomatic subjects without cardiovascular disease enrolled in MiHEART. Quantitative assessment of plaque volume was performed by using artificial intelligence–guided quantitative coronary computed tomography angiography (AI-QCT) analysis. The percentiles of the plaque distribution were estimated with nonparametric techniques.
Results
Mean age of the participants was 53.5 years, and 50.4% were male. The median total plaque volume was 54 mm3 (Q1-Q3: 16-126 mm3) and increased with age. Male subjects had greater median total plaque volume than female subjects (80 mm3 [Q1-Q3: 31-181 mm3] vs 34 mm3 [Q1-Q3: 9-85 mm3]; P < 0.001); there was no difference according to race/ethnicity (Hispanic 53 mm3 [Q1-Q3: 14-119 mm3] vs non-Hispanic 54 mm3 [Q1-Q3: 17-127 mm3]; P = 0.756). The prevalence of subjects with total plaque volume ≥20 mm3 was 81.5% in male subjects and 61.9% in female subjects. Younger individuals had a greater percentage of noncalcified plaque.
Conclusions
The large majority of study subjects had plaque detected by using AI-QCT. Furthermore, age- and sex-specific nomograms provided information on the plaque volume distribution in an asymptomatic population. (Miami Heart Study [MiHEART] at Baptist Health South Florida; NCT02508454)
背景冠状动脉ct血管造影（CTA）所得斑块负担与心血管事件风险相关，有望用于临床实践。了解普通人群中基于计算机断层扫描的定量斑块体积的规范值对于确定患者管理具有重要的临床意义。目的：本研究旨在调查斑块体积在普通人群中的分布，并利用MiHEART（迈阿密心脏研究）在南佛罗里达浸信会健康中心开展一项大型社区队列研究。方法该研究纳入了2301名无心血管疾病的无症状受试者。通过人工智能引导的定量冠状动脉计算机断层血管造影（AI-QCT）分析对斑块体积进行定量评估。用非参数技术估计斑块分布的百分位数。结果参与者平均年龄53.5岁，男性占50.4%。中位总斑块体积为54 mm3 (Q1-Q3: 16-126 mm3)，随着年龄的增长而增加。男性受试者的中位总斑块体积大于女性受试者（80 mm3 [Q1-Q3: 31-181 mm3] vs 34 mm3 [Q1-Q3: 9-85 mm3], P < 0.001）；根据种族/民族没有差异（西班牙裔53 mm3 [Q1-Q3: 14-119 mm3]与非西班牙裔54 mm3 [Q1-Q3: 17-127 mm3]； P = 0.756）。总斑块体积≥20mm3的男性患病率为81.5%，女性患病率为61.9%。年轻人的非钙化斑块比例更高。结论AI-QCT可检测到绝大多数研究对象的斑块。此外，年龄和性别特异性的形态图提供了无症状人群中斑块体积分布的信息。（迈阿密心脏研究[MiHEART]浸信会健康南佛罗里达；NCT02508454）。
{"title":"Coronary Plaque Volume in an Asymptomatic Population","authors":"Keishi Ichikawa MD, PhD , Shai Ronen PhD , Rachelle Bishay BS , Srikanth Krishnan MD, MSc , Travis Benzing MD , Sina Kianoush MD , Jairo Aldana-Bitar MD , Miguel Cainzos-Achirica MD, MPH, PhD , Theodore Feldman MD , Jonathan Fialkow MD , Matthew J. Budoff MD , Khurram Nasir MD, MPH, MSc","doi":"10.1016/j.jcmg.2025.08.001","DOIUrl":"10.1016/j.jcmg.2025.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Coronary computed tomography angiography (CTA)-derived plaque burden is associated with the risk of cardiovascular events and is expected to be used in clinical practice. Understanding the normative values of computed tomography–based quantitative plaque volume in the general population is clinically important for determining patient management.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the distribution of plaque volume in the general population and to develop nomograms using MiHEART (Miami Heart Study) at Baptist Health South Florida, a large community-based cohort study.</div></div><div><h3>Methods</h3><div>The study included 2,301 asymptomatic subjects without cardiovascular disease enrolled in MiHEART. Quantitative assessment of plaque volume was performed by using artificial intelligence–guided quantitative coronary computed tomography angiography (AI-QCT) analysis. The percentiles of the plaque distribution were estimated with nonparametric techniques.</div></div><div><h3>Results</h3><div>Mean age of the participants was 53.5 years, and 50.4% were male. The median total plaque volume was 54 mm<sup>3</sup> (Q1-Q3: 16-126 mm<sup>3</sup>) and increased with age. Male subjects had greater median total plaque volume than female subjects (80 mm<sup>3</sup> [Q1-Q3: 31-181 mm<sup>3</sup>] vs 34 mm<sup>3</sup> [Q1-Q3: 9-85 mm<sup>3</sup>]; <em>P <</em> 0.001); there was no difference according to race/ethnicity (Hispanic 53 mm<sup>3</sup> [Q1-Q3: 14-119 mm<sup>3</sup>] vs non-Hispanic 54 mm<sup>3</sup> [Q1-Q3: 17-127 mm<sup>3</sup>]; <em>P =</em> 0.756). The prevalence of subjects with total plaque volume ≥20 mm<sup>3</sup> was 81.5% in male subjects and 61.9% in female subjects. Younger individuals had a greater percentage of noncalcified plaque.</div></div><div><h3>Conclusions</h3><div>The large majority of study subjects had plaque detected by using AI-QCT. Furthermore, age- and sex-specific nomograms provided information on the plaque volume distribution in an asymptomatic population. (Miami Heart Study [MiHEART] at Baptist Health South Florida; <span><span>NCT02508454</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 1","pages":"Pages 49-60"},"PeriodicalIF":15.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jcmg.2025.10.004
Maya Guglin MD, PhD
{"title":"When the Right Shunt Is the Right Choice?","authors":"Maya Guglin MD, PhD","doi":"10.1016/j.jcmg.2025.10.004","DOIUrl":"10.1016/j.jcmg.2025.10.004","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 1","pages":"Pages 16-17"},"PeriodicalIF":15.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jcmg.2025.08.005
Michael R. Zile MD , William T. Abraham MD , JoAnn Lindenfeld MD , Stefan D. Anker MD, PhD , Josep Rodés-Cabau MD, PhD , Michael P. Pfeiffer MD , John P. Boehmer MD , Sheldon Litwin MD , Catalin F. Baicu PhD , Julio Núñez Villota MD, PhD , Elizabeth C. Lee MD , Richard Holcomb PhD , Patrick O’Keefe PhD , Neal L. Eigler MD , Gregg W. Stone MD , RELIEVE-HF Investigators
Background
The RELIEVE-HF (REducing Lung congestion symptoms using the v-wavE shunt in adVancEd Heart Failure) trial randomized 508 patients with heart failure (HF) to interatrial shunt treatment vs placebo procedure. Randomization was stratified into 2 patient groups: heart failure with reduced ejection fraction (HFrEF) (left ventricular ejection fraction [LVEF] ≤40%); and heart failure with preserved ejection fraction (HFpEF) (LVEF >40%). HF event rates (all-cause death, transplantation or left ventricular (LV) assist device, HF hospitalization or outpatient worsening) after shunt treatment during 2-year follow-up were directionally opposite: decreased by 51% in HFrEF, increased by 69% in HFpEF.
Objectives
This study aims to examine differences in cardiac structure and function before and after interatrial shunt placement in patients with HFrEF vs HFpEF that could underlie these discordant clinical outcomes.
Methods
Serial changes from baseline to 12 months in 17 transthoracic echocardiographic parameters in shunt-treated vs control patients in HFrEF vs HFpEF were assessed and compared by ANCOVA (analysis of covariance).
Results
In shunt-treated vs control patients with HFrEF, there were reductions in median LV end-diastolic volumes (−11.9 mL/m2 [Q1-Q3: −21.3 to −2.5 mL/m2]; P = 0.01) and LV end-systolic volumes (−8.9 mL/m2 [Q1-Q3: −17.2 to −20.7 mL/m2]; P = 0.01) indicative of reverse LV remodeling. There were no significant changes in right ventricular (RV), right atrial, or inferior vena cava sizes or pulmonary artery systolic pressure (PASP). In contrast, shunt-treated vs control patients with HFpEF did not have LV remodeling, but they had increased RV, right atrial, and inferior vena cava dimensions, and PASP also increased (4.7 mm Hg [Q1-Q3: 0.9-8.5 mm Hg]; P = 0.02). LV and RV diastolic compliance were decreased in HFpEF vs HFrEF at baseline and decreased further after shunt treatment in HFpEF.
Conclusions
Differential changes in left-sided and right-sided heart remodeling and PASP following interatrial shunt placement in patients with HFrEF vs HFpEF provide a mechanistic basis for the variable effects on clinical outcomes observed in RELIEVE-HF. (REducing Lung congestion symptoms using the v-wavE shunt in adVancEd Heart Failure [RELIEVE-HF]; NCT03499236)
{"title":"Mechanistic Basis for Differential Effects of Interatrial Shunt Treatment in HFrEF vs HFpEF","authors":"Michael R. Zile MD , William T. Abraham MD , JoAnn Lindenfeld MD , Stefan D. Anker MD, PhD , Josep Rodés-Cabau MD, PhD , Michael P. Pfeiffer MD , John P. Boehmer MD , Sheldon Litwin MD , Catalin F. Baicu PhD , Julio Núñez Villota MD, PhD , Elizabeth C. Lee MD , Richard Holcomb PhD , Patrick O’Keefe PhD , Neal L. Eigler MD , Gregg W. Stone MD , RELIEVE-HF Investigators","doi":"10.1016/j.jcmg.2025.08.005","DOIUrl":"10.1016/j.jcmg.2025.08.005","url":null,"abstract":"<div><h3>Background</h3><div>The RELIEVE-HF (REducing Lung congestion symptoms using the v-wavE shunt in adVancEd Heart Failure) trial randomized 508 patients with heart failure (HF) to interatrial shunt treatment vs placebo procedure. Randomization was stratified into 2 patient groups: heart failure with reduced ejection fraction (HFrEF) (left ventricular ejection fraction [LVEF] ≤40%); and heart failure with preserved ejection fraction (HFpEF) (LVEF >40%). HF event rates (all-cause death, transplantation or left ventricular (LV) assist device, HF hospitalization or outpatient worsening) after shunt treatment during 2-year follow-up were directionally opposite: decreased by 51% in HFrEF, increased by 69% in HFpEF.</div></div><div><h3>Objectives</h3><div>This study aims to examine differences in cardiac structure and function before and after interatrial shunt placement in patients with HFrEF vs HFpEF that could underlie these discordant clinical outcomes.</div></div><div><h3>Methods</h3><div>Serial changes from baseline to 12 months in 17 transthoracic echocardiographic parameters in shunt-treated vs control patients in HFrEF vs HFpEF were assessed and compared by ANCOVA (analysis of covariance).</div></div><div><h3>Results</h3><div>In shunt-treated vs control patients with HFrEF, there were reductions in median LV end-diastolic volumes (−11.9 mL/m<sup>2</sup> [Q1-Q3: −21.3 to −2.5 mL/m<sup>2</sup>]; <em>P =</em> 0.01) and LV end-systolic volumes (−8.9 mL/m<sup>2</sup> [Q1-Q3: −17.2 to −20.7 mL/m<sup>2</sup>]; <em>P =</em> 0.01) indicative of reverse LV remodeling. There were no significant changes in right ventricular (RV), right atrial, or inferior vena cava sizes or pulmonary artery systolic pressure (PASP). In contrast, shunt-treated vs control patients with HFpEF did not have LV remodeling, but they had increased RV, right atrial, and inferior vena cava dimensions, and PASP also increased (4.7 mm Hg [Q1-Q3: 0.9-8.5 mm Hg]; <em>P =</em> 0.02). LV and RV diastolic compliance were decreased in HFpEF vs HFrEF at baseline and decreased further after shunt treatment in HFpEF.</div></div><div><h3>Conclusions</h3><div>Differential changes in left-sided and right-sided heart remodeling and PASP following interatrial shunt placement in patients with HFrEF vs HFpEF provide a mechanistic basis for the variable effects on clinical outcomes observed in RELIEVE-HF. (REducing Lung congestion symptoms using the v-wavE shunt in adVancEd Heart Failure [RELIEVE-HF]; <span><span>NCT03499236</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 1","pages":"Pages 1-15"},"PeriodicalIF":15.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jcmg.2025.08.019
Xuan Ma MD , Yun Tang MD , Xingrui Chen MD , Shujuan Yang MD , Jiaxin Wang MD , Kai Yang MD , Zhixiang Dong MD , Zhuxin Wei MD , Xi Jia MD , Yujie Liu MD , Pengyu Zhou MD , Kankan Zhao PhD , Yanyan Song MD , Minjie Lu MD, PhD , Xiuyu Chen MD , Shihua Zhao MD, PhD
Background
Left ventricular (LV)-global longitudinal strain (GLS) assessed by cardiac magnetic resonance (CMR) feature tracking is an emerging marker for predicting adverse outcomes in hypertrophic cardiomyopathy (HCM), but its incremental prognostic value and mechanistic role in sudden cardiac death (SCD) risk stratification remain unclear.
Objectives
The study sought to evaluate whether LV-GLS adds prognostic value beyond current ESC (European Society of Cardiology) and ACC (American College of Cardiology)/AHA (American Heart Association) SCD risk models, and mediates the relationship between myocardial abnormalities and SCD risk in HCM.
Methods
The authors retrospectively analyzed 2,009 patients with HCM (mean age: 50 ± 14 years, 70% men) who underwent CMR between 2010 and 2017. LV-GLS was quantified using cine CMR feature tracking. The primary endpoint included SCD and aborted SCD. Prognostic performance was assessed using time-dependent receiver-operating characteristic analysis and competing risk regression. Mediation analysis was used to investigate how LV-GLS mediated associations between myocardial hypertrophy, fibrosis, and SCD.
Results
Over a median follow-up of 88.2 months, 85 (4.2%) patients experienced SCD events. These patients had significantly lower absolute LV-GLS values (9.0% ± 3.6% vs 11.1% ± 3.6%; P < 0.001). In competing-risk regression, LV-GLS independently predicted SCD after adjustment for ESC (subdistribution HR [sHR]: 1.12 per 1% decrease [95% CI: 1.06-1.22]; P < 0.001) and ACC/AHA risk factors (sHR: 1.09 [95% CI: 1.02-1.18]; P = 0.016). Adding LV-GLS improved the 5-year predictive accuracy of both ESC and ACC/AHA models (AUC from 0.72 to 0.77 and from 0.71 to 0.76, respectively). Absolute LV-GLS with a cutoff of 9.23% further stratified risk in patient subgroups with either class II or class III implantable cardioverter-defibrillator indications (all log-rank P < 0.001). Mediation analysis showed LV-GLS partially mediated the effect of maximum wall thickness and extent of fibrosis on SCD (proportion-mediated: 17.5% and 23.1%, respectively; both P < 0.001).
Conclusions
In patients with HCM, CMR-derived LV-GLS is an incremental predictor of SCD beyond current guideline-based risk models and partially mediates the association between myocardial abnormalities and SCD.
背景：通过心脏磁共振（CMR）特征跟踪评估左心室(LV)-全局纵向应变（GLS）是预测肥厚性心肌病（HCM）不良结局的新兴标志物，但其增量预后价值和在心源性猝死（SCD）风险分层中的机制作用尚不清楚。目的：本研究旨在评估LV-GLS是否在现有ESC（欧洲心脏病学会）和ACC（美国心脏病学会）/AHA（美国心脏协会）SCD风险模型之外增加了预后价值，并介导HCM中心肌异常和SCD风险之间的关系。方法回顾性分析2010年至2017年期间接受CMR治疗的2009例HCM患者（平均年龄：50±14岁，70%为男性）。采用电影CMR特征跟踪量化LV-GLS。主要终点包括SCD和流产的SCD。预后表现评估采用时间依赖的接受者-操作特征分析和竞争风险回归。采用中介分析探讨LV-GLS如何介导心肌肥大、纤维化和SCD之间的关联。结果中位随访88.2个月，85例（4.2%）患者发生SCD事件。这些患者的LV-GLS绝对值明显降低（9.0%±3.6% vs 11.1%±3.6%;P < 0.001）。在竞争风险回归中，LV-GLS在调整ESC（亚分布HR [sHR]: 1.12 / 1%降低[95% CI: 1.06-1.22]; P < 0.001）和ACC/AHA危险因素（sHR: 1.09 [95% CI: 1.02-1.18]; P = 0.016）后独立预测SCD。添加LV-GLS提高了ESC和ACC/AHA模型的5年预测精度（AUC分别从0.72到0.77和0.71到0.76）。在II类或III类植入式心律转复除颤器适应症的患者亚组中，绝对LV-GLS的截止值为9.23%，进一步分层风险（所有log-rank P < 0.001）。中介分析显示，LV-GLS部分介导最大壁厚和纤维化程度对SCD的影响（比例介导：分别为17.5%和23.1%，P均< 0.001）。结论：在HCM患者中，cmr衍生的LV-GLS是SCD的增量预测因子，超出了目前基于指南的风险模型，并部分介导心肌异常与SCD之间的关联。
{"title":"Feature Tracking–Derived Global Longitudinal Strain Enhances Risk Stratification for Sudden Cardiac Death in Hypertrophic Cardiomyopathy","authors":"Xuan Ma MD , Yun Tang MD , Xingrui Chen MD , Shujuan Yang MD , Jiaxin Wang MD , Kai Yang MD , Zhixiang Dong MD , Zhuxin Wei MD , Xi Jia MD , Yujie Liu MD , Pengyu Zhou MD , Kankan Zhao PhD , Yanyan Song MD , Minjie Lu MD, PhD , Xiuyu Chen MD , Shihua Zhao MD, PhD","doi":"10.1016/j.jcmg.2025.08.019","DOIUrl":"10.1016/j.jcmg.2025.08.019","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular (LV)-global longitudinal strain (GLS) assessed by cardiac magnetic resonance (CMR) feature tracking is an emerging marker for predicting adverse outcomes in hypertrophic cardiomyopathy (HCM), but its incremental prognostic value and mechanistic role in sudden cardiac death (SCD) risk stratification remain unclear.</div></div><div><h3>Objectives</h3><div>The study sought to evaluate whether LV-GLS adds prognostic value beyond current ESC (European Society of Cardiology) and ACC (American College of Cardiology)/AHA (American Heart Association) SCD risk models, and mediates the relationship between myocardial abnormalities and SCD risk in HCM.</div></div><div><h3>Methods</h3><div>The authors retrospectively analyzed 2,009 patients with HCM (mean age: 50 ± 14 years, 70% men) who underwent CMR between 2010 and 2017. LV-GLS was quantified using cine CMR feature tracking. The primary endpoint included SCD and aborted SCD. Prognostic performance was assessed using time-dependent receiver-operating characteristic analysis and competing risk regression. Mediation analysis was used to investigate how LV-GLS mediated associations between myocardial hypertrophy, fibrosis, and SCD.</div></div><div><h3>Results</h3><div>Over a median follow-up of 88.2 months, 85 (4.2%) patients experienced SCD events. These patients had significantly lower absolute LV-GLS values (9.0% ± 3.6% vs 11.1% ± 3.6%; <em>P</em> < 0.001). In competing-risk regression, LV-GLS independently predicted SCD after adjustment for ESC (subdistribution HR [sHR]: 1.12 per 1% decrease [95% CI: 1.06-1.22]; <em>P <</em> 0.001) and ACC/AHA risk factors (sHR: 1.09 [95% CI: 1.02-1.18]; <em>P =</em> 0.016). Adding LV-GLS improved the 5-year predictive accuracy of both ESC and ACC/AHA models (AUC from 0.72 to 0.77 and from 0.71 to 0.76, respectively). Absolute LV-GLS with a cutoff of 9.23% further stratified risk in patient subgroups with either class II or class III implantable cardioverter-defibrillator indications (all log-rank <em>P <</em> 0.001). Mediation analysis showed LV-GLS partially mediated the effect of maximum wall thickness and extent of fibrosis on SCD (proportion-mediated: 17.5% and 23.1%, respectively; both <em>P <</em> 0.001).</div></div><div><h3>Conclusions</h3><div>In patients with HCM, CMR-derived LV-GLS is an incremental predictor of SCD beyond current guideline-based risk models and partially mediates the association between myocardial abnormalities and SCD.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 1","pages":"Pages 33-45"},"PeriodicalIF":15.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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