@article{discovery10204143,
           month = {January},
           title = {Demographic-Based Personalized Left Ventricular Hypertrophy Thresholds for Hypertrophic Cardiomyopathy Diagnosis},
            note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.},
            year = {2025},
         journal = {Journal of the American College of Cardiology},
       publisher = {Elsevier},
          author = {Shiwani, Hunain and Davies, Rhodri H and Topriceanu, Constantin-Cristian and Ditaranto, Raffaello and Owens, Anjali and Raman, Betty and Augusto, Jo{\~a}o and Hughes, Rebecca K and Torlasco, Camilla and Dowsing, Ben and Artico, Jessica and Joy, George and Miranda, In{\^e}s and Witschey, Walter and Rodriguez-Palomares, Jose F and Badia-Molins, Clara and Crotti, Lia and Cortina-Borja, Mario and Chuang, Michael L and Kwong, Raymond Y and Kramer, Christopher M and Manning, Warren and Ho, Carolyn Y and Kellman, Peter and Hughes, Alun D and Biagini, Elena and Mohiddin, Saidi and Lopes, Luis and Litt, Harold and Ferrari, Victor A and Captur, Gabriella and Moon, James C and PRECISION-HCM Collaborative, {}},
             url = {https://doi.org/10.1016/j.jacc.2024.10.082},
            issn = {0735-1097},
        abstract = {Background:
Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death. Current diagnosis emphasizes the detection of left ventricular hypertrophy (LVH) using a fixed threshold of {$\ge$}15-mm maximum wall thickness (MWT). This study proposes a method that considers individual demographics to adjust LVH thresholds as an alternative to a 1-size-fits-all approach.
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Methods:
Left ventricular MWT was measured in 3 cohorts: a Reference Cohort of healthy adults (n = 5,067, no comorbidities), a Population Cohort (n = 43,239, with comorbidities), and an HCM Cohort from 6 international centers (n = 2,424). Measurement used cardiovascular magnetic resonance (CMR) and a validated artificial intelligence algorithm. The Reference Cohort was used to developed demographically adjusted LVH thresholds, and individualized z-scores based on age, sex, and body surface area (BSA), which were used to explore the other cohorts.
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Results:
The traditional {$\ge$}15-mm threshold classified 4.3\% (n = 1,854) of the Population Cohort as hypertrophic, with a significant sex skew (89\% male). Demographic-adjusted LVH thresholds (range: 10-17 mm) reduced ascertainment to 2.2\% (n = 945), reducing the sex skew (56\% male). Similar reductions in bias with height, weight, and age also occurred. The HCM cohort was found to have a 2:1 male-to-female ratio. A significant proportion of patients received diagnoses of HCM despite having MWT below the traditional LVH threshold ({\ensuremath{<}}15 mm): 27\% of female individuals and 18\% of male individuals. Using demographic-adjusted LVH thresholds reduced these proportions to 7\% of female individuals and 15\% of male individuals (P {\ensuremath{<}} 0.0001). Female patients had lower absolute MWT (18 mm vs 19 mm; P {\ensuremath{<}} 0.001) but higher MWT z-scores (5.1 vs 4.5; P = 0.05).
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Conclusions:
Age, sex, and body size influence the normal heart MWT. Using a fixed LVH threshold {$\ge$}15 mm biases LVH ascertainment in both population and HCM cohorts. A demographic-adjusted approach for LVH improves ascertainment and diagnostic accuracy.},
        keywords = {Cardiac magnetic resonance; hypertrophic cardiomyopathy; left ventricular hypertrophy}
}