eprintid: 10204143 rev_number: 8 eprint_status: archive userid: 699 dir: disk0/10/20/41/43 datestamp: 2025-01-29 11:43:45 lastmod: 2025-01-29 11:47:07 status_changed: 2025-01-29 11:43:45 type: article metadata_visibility: show sword_depositor: 699 creators_name: Shiwani, Hunain creators_name: Davies, Rhodri H creators_name: Topriceanu, Constantin-Cristian creators_name: Ditaranto, Raffaello creators_name: Owens, Anjali creators_name: Raman, Betty creators_name: Augusto, João creators_name: Hughes, Rebecca K creators_name: Torlasco, Camilla creators_name: Dowsing, Ben creators_name: Artico, Jessica creators_name: Joy, George creators_name: Miranda, Inês creators_name: Witschey, Walter creators_name: Rodriguez-Palomares, Jose F creators_name: Badia-Molins, Clara creators_name: Crotti, Lia creators_name: Cortina-Borja, Mario creators_name: Chuang, Michael L creators_name: Kwong, Raymond Y creators_name: Kramer, Christopher M creators_name: Manning, Warren creators_name: Ho, Carolyn Y creators_name: Kellman, Peter creators_name: Hughes, Alun D creators_name: Biagini, Elena creators_name: Mohiddin, Saidi creators_name: Lopes, Luis creators_name: Litt, Harold creators_name: Ferrari, Victor A creators_name: Captur, Gabriella creators_name: Moon, James C creators_name: PRECISION-HCM Collaborative, title: Demographic-Based Personalized Left Ventricular Hypertrophy Thresholds for Hypertrophic Cardiomyopathy Diagnosis ispublished: inpress divisions: UCL divisions: B02 divisions: D14 divisions: D13 divisions: GA4 divisions: GA3 divisions: G25 keywords: Cardiac magnetic resonance; hypertrophic cardiomyopathy; left ventricular hypertrophy note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. 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 ≥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. date: 2025-01-08 date_type: published publisher: Elsevier official_url: https://doi.org/10.1016/j.jacc.2024.10.082 full_text_type: other language: eng verified: verified_manual elements_id: 2351924 doi: 10.1016/j.jacc.2024.10.082 medium: Print-Electronic pii: S0735-1097(24)10044-7 lyricists_name: Moon, James lyricists_name: Hughes, Alun lyricists_name: Shiwani, Hunain lyricists_name: Topriceanu, Constantin-Cristian lyricists_name: Cortina Borja, Mario lyricists_name: Da Rocha Lopes, Luis lyricists_name: Davies, Rhodri lyricists_name: Dowsing, Benjamin lyricists_id: JMOON31 lyricists_id: ADHUG42 lyricists_id: HHSHI74 lyricists_id: CTOPR46 lyricists_id: MCORT36 lyricists_id: LMDAR34 lyricists_id: RDAVA45 lyricists_id: BMDOW26 actors_name: Mustafa, Adelat actors_id: AMUST21 actors_role: owner full_text_status: restricted publication: Journal of the American College of Cardiology event_location: United States issn: 0735-1097 citation: Shiwani, Hunain; Davies, Rhodri H; Topriceanu, Constantin-Cristian; Ditaranto, Raffaello; Owens, Anjali; Raman, Betty; Augusto, João; ... PRECISION-HCM Collaborative; + view all <#> Shiwani, Hunain; Davies, Rhodri H; Topriceanu, Constantin-Cristian; Ditaranto, Raffaello; Owens, Anjali; Raman, Betty; Augusto, João; Hughes, Rebecca K; Torlasco, Camilla; Dowsing, Ben; Artico, Jessica; Joy, George; Miranda, Inês; Witschey, Walter; Rodriguez-Palomares, Jose F; Badia-Molins, Clara; Crotti, Lia; Cortina-Borja, Mario; Chuang, Michael L; Kwong, Raymond Y; Kramer, Christopher M; Manning, Warren; Ho, Carolyn Y; Kellman, Peter; Hughes, Alun D; Biagini, Elena; Mohiddin, Saidi; Lopes, Luis; Litt, Harold; Ferrari, Victor A; Captur, Gabriella; Moon, James C; PRECISION-HCM Collaborative; - view fewer <#> (2025) Demographic-Based Personalized Left Ventricular Hypertrophy Thresholds for Hypertrophic Cardiomyopathy Diagnosis. Journal of the American College of Cardiology 10.1016/j.jacc.2024.10.082 <https://doi.org/10.1016/j.jacc.2024.10.082>. (In press). document_url: https://discovery.ucl.ac.uk/id/eprint/10204143/1/Hughes_Shiwani-JACC060424-2112R.pdf