TY  - INPR
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
AV  - restricted
Y1  - 2025/01/08/
TI  - Demographic-Based Personalized Left Ventricular Hypertrophy Thresholds for Hypertrophic Cardiomyopathy Diagnosis
A1  - Shiwani, Hunain
A1  - Davies, Rhodri H
A1  - Topriceanu, Constantin-Cristian
A1  - Ditaranto, Raffaello
A1  - Owens, Anjali
A1  - Raman, Betty
A1  - Augusto, João
A1  - Hughes, Rebecca K
A1  - Torlasco, Camilla
A1  - Dowsing, Ben
A1  - Artico, Jessica
A1  - Joy, George
A1  - Miranda, Inês
A1  - Witschey, Walter
A1  - Rodriguez-Palomares, Jose F
A1  - Badia-Molins, Clara
A1  - Crotti, Lia
A1  - Cortina-Borja, Mario
A1  - Chuang, Michael L
A1  - Kwong, Raymond Y
A1  - Kramer, Christopher M
A1  - Manning, Warren
A1  - Ho, Carolyn Y
A1  - Kellman, Peter
A1  - Hughes, Alun D
A1  - Biagini, Elena
A1  - Mohiddin, Saidi
A1  - Lopes, Luis
A1  - Litt, Harold
A1  - Ferrari, Victor A
A1  - Captur, Gabriella
A1  - Moon, James C
A1  - PRECISION-HCM Collaborative
KW  - Cardiac magnetic resonance; hypertrophic cardiomyopathy; left ventricular hypertrophy
JF  - Journal of the American College of Cardiology
UR  - https://doi.org/10.1016/j.jacc.2024.10.082
PB  - Elsevier
SN  - 0735-1097
N2  - 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.
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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 ?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).
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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.
ID  - discovery10204143
ER  -