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HCM Risk Stratification — EECC MCQ

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ModerateCardiac ImagingHCM Risk StratificationEECC

A 48-year-old man with HCM and a maximum wall thickness of 25 mm undergoes CMR for SCD risk stratification. Extensive LGE is found involving 18% of LV mass. His HCM Risk-SCD 5-year score without CMR data is 3.2%. How does the LGE finding affect risk stratification?

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Correct answer: D — Extensive LGE (15% or more of LV mass) is a risk modifier that may tip the decision toward ICD implantation in borderline-risk patients

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

Per the 2023 ESC Cardiomyopathy Guidelines, extensive LGE (15% or more of LV mass) is a recognised risk modifier for SCD in HCM. While the HCM Risk-SCD calculator does not directly incorporate LGE, extensive LGE should be considered as an additional factor in borderline-risk patients. LGE does have prognostic significance (A is wrong). It does not automatically mandate ICD (C). The 15% threshold is relevant (D is incorrect). LGE represents fibrosis which is proarrhythmic (E is incorrect).

Reference: ESC (2023): Guidelines for the Management of Cardiomyopathies