[The predictive value of left ventricular strain on cardiac magnetic resonance for adverse events in children and adolescent patients with hypertrophic cardiomyopathy].
Chen X, Ma X, et al. • Zhonghua xin xue guan bing za zhi • 2026
CMR feature-tracking can effectively assess left ventricular systolic function in children and adolescents with primary HCM, and left ventricular GLS and LGE percentage are independently associated with the risk of adverse cardiovascular events and heart failure-related events in this population.
Key Findings
Results
In 249 children and adolescents with primary HCM followed for a mean of about 5.5 years, 37 patients (14.9%) had a composite adverse cardiovascular event.
The cohort comprised 249 patients aged ≤21 years (mean age 14.81±3.71 years); 163 (65.5%) were male.
Follow-up duration was (66.59±33.00) months.
The 37 composite endpoint events comprised 17 heart failure-related events and 20 sudden cardiac death events; 212 patients remained event-free.
The study was a single-center retrospective cohort at Fuwai Hospital, with patients enrolled January 2010 to December 2018.
Results
Left ventricular GLS was independently associated with composite adverse cardiovascular events in multivariate Cox regression.
Left ventricular GLS: HR=1.18, 95%CI 1.04-1.35, P=0.014.
The model was adjusted for confounders such as left ventricular ejection fraction and history of unexplained syncope.
Higher (less negative, more impaired) GLS corresponded to higher risk.
Results
LGE extent (percentage) was independently associated with composite adverse cardiovascular events.
LGE extent: HR=1.12, 95%CI 1.06-1.18, P<0.001.
Adjusted in multivariate Cox proportional-hazards models alongside GLS, LVEF, and history of unexplained syncope.
Results
Left ventricular GLS and LGE percentage were both independently associated with heart failure-related events, with a stronger GLS hazard ratio than for the composite endpoint.
Left ventricular GLS: HR=1.52, 95%CI 1.18-1.96, P=0.001.
LGE extent: HR=1.14, 95%CI 1.04-1.24, P=0.003.
There were 17 heart failure-related events (the secondary endpoint).
Results
Patients with impaired GLS (>-9.2%) had lower cumulative event-free survival than those with preserved GLS (≤-9.2%) for both composite adverse events and heart failure-related events.
The cut-off was the cohort median left ventricular GLS of -9.2%.
Kaplan-Meier analysis with log-rank test: P<0.001 for both endpoints.
The cut-off was data-derived (median) rather than an externally validated threshold.
Conclusions
The authors conclude that CMR feature-tracking can effectively assess left ventricular systolic function in pediatric and adolescent primary HCM.
GLS provided prognostic information beyond LVEF, as the models were adjusted for LVEF.
The conclusion applies to patients with primary HCM aged ≤21 years in this single-center cohort.
What This Means
This study looked at 249 children and young people (up to age 21) with a heart-muscle thickening condition called hypertrophic cardiomyopathy (HCM). All had a cardiac MRI scan at one hospital in China, and they were followed for about 5.5 years on average. The researchers examined whether a measure of how well the heart's main pumping chamber shortens during each beat (global longitudinal strain, or GLS), measured from the MRI images, could predict later serious heart problems.
During follow-up, 37 patients had a serious event: 17 had heart failure-related events and 20 had sudden cardiac death. Worse GLS and more scarring on the MRI (late gadolinium enhancement, or LGE) were each linked to higher risk, even after accounting for other factors such as ejection fraction and prior unexplained fainting. Patients whose GLS was worse than the group median (-9.2%) were less likely to stay free of serious events and heart failure over time than those with better GLS.
This research suggests that strain measured on routine cardiac MRI, together with the amount of scar tissue, may help identify young people with HCM at higher risk. The study was retrospective, was done at a single center, and had a modest number of events, so the findings would need confirmation in other groups before changing practice.
Chen X, Ma X, Zhang A, Tang Y, Yang K, Chen X, et al.. (2026). [The predictive value of left ventricular strain on cardiac magnetic resonance for adverse events in children and adolescent patients with hypertrophic cardiomyopathy].. Zhonghua xin xue guan bing za zhi. https://doi.org/10.3760/cma.j.cn112148-20260612-00396