%0 Journal Article
%@ 0735-1097
%A Shiwani, Hunain
%A Davies, Rhodri H
%A Topriceanu, Constantin-Cristian
%A Ditaranto, Raffaello
%A Owens, Anjali
%A Raman, Betty
%A Augusto, João
%A Hughes, Rebecca K
%A Torlasco, Camilla
%A Dowsing, Ben
%A Artico, Jessica
%A Joy, George
%A Miranda, Inês
%A Witschey, Walter
%A Rodriguez-Palomares, Jose F
%A Badia-Molins, Clara
%A Crotti, Lia
%A Cortina-Borja, Mario
%A Chuang, Michael L
%A Kwong, Raymond Y
%A Kramer, Christopher M
%A Manning, Warren
%A Ho, Carolyn Y
%A Kellman, Peter
%A Hughes, Alun D
%A Biagini, Elena
%A Mohiddin, Saidi
%A Lopes, Luis
%A Litt, Harold
%A Ferrari, Victor A
%A Captur, Gabriella
%A Moon, James C
%A PRECISION-HCM Collaborative
%D 2025
%F discovery:10204143
%I Elsevier
%J Journal of the American College of Cardiology
%K Cardiac magnetic resonance; hypertrophic cardiomyopathy; left ventricular hypertrophy
%T Demographic-Based Personalized Left Ventricular Hypertrophy Thresholds for Hypertrophic Cardiomyopathy Diagnosis
%U https://discovery.ucl.ac.uk/id/eprint/10204143/
%X 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 ≥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.  //  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.  //  Results:  The traditional ≥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 (<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 < 0.0001). Female patients had lower absolute MWT (18 mm vs 19 mm; P < 0.001) but higher MWT z-scores (5.1 vs 4.5; P = 0.05).  //  Conclusions:  Age, sex, and body size influence the normal heart MWT. Using a fixed LVH threshold ≥15 mm biases LVH ascertainment in both population and HCM cohorts. A demographic-adjusted approach for LVH improves ascertainment and diagnostic accuracy.
%Z This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.