CarDiac magnEtic resonance for prophylactic implantable cardioVerter defibrillAtor ThErapy in ischemic dilated CardioMyopathy: Prognostic implication of papillary muscles involvement.
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Muscogiuri Giuseppe, Guaricci Andrea Igoren, Fusini Laura, Senatieri Alberto, Abete Raffaele, Aquaro Giovanni Donato, Baggiano Andrea, Barison Andrea, Bogaert Jan, Calo' Leonardo, Camastra Giovanni, Carella Maria Cristina, Carigi Samuela, Carrabba Nazario, Casavecchia Grazia, Censi Stefano, Cicala Gloria, De Cecco Carlo N, Ciccone Marco Matteo, De Lazzari Manuel, Di Giovine Gabriella, Dobrovie Monica, Focardi Marta, Gaibazzi Nicola, Gismondi Annalaura, Gravina Matteo, Guglielmo Marco, Lanzillo Chiara, Lombardi Massimo, Lorenzoni Valentina, Lozano-Torres Jordi, Margonato Davide, Martini Chiara, Marzo Francesca, Masci Pier-Giorgio, Masi Ambra, Moro Claudio, Mushtaq Saima, Nese Alberto, Palumbo Alessandro, Pavon Anna Giulia, Pedrotti Patrizia, Marra Martina Perazzolo, Pradella Silvia, Presicci Cristina, Rabbat Mark G, Raineri Claudia, Rodriguez-Palomares Jose' F, Sbarbati Stefano, Varga-Szemes Akos, Squeri Angelo, Sverzellati Nicola, Symons Rolf, Tat Emily, Timpani Mauro, Todiere Giancarlo, Valentini Adele, Volpe Alessandra, Sironi Sandro, Schwitter Juerg, Pontone Gianluca
Аннотация
METHODS: Eighty-hundred-thirty-nine patients (mean age 65 ± 11 years; males:721[86%]) with ICM and TTE-LVEF <50% were enrolled from the DERIVATE-ICM registry (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy- Ischemic Cardiomyopathy). Major adverse arrhythmic cardiac events (MAACE) were the primary endpoints.
RESULTS: During a median follow-up of 1054 days, MAACE occurred in 86 (9.7%). DERIVATE-ICM Risk Score quartiles Q2-Q3 (HR:2.124 [95% CI:1.084-4.162]; p = 0.028), Q4 (HR: 3.865 [95% CI: 1.875-7.970]; p < 0.001) and the involvement of isolated posteromedial (P)PM (HR:1.985 [95% CI:1.073-3.673]; p = 0.029) were independent predictors of MAACE. The Kaplan-Meier survival curves showed a higher event-free rate in absence of LGE-PPM in patients categorized in the DERIVATE-ICM Risk Score quartiles Q2-Q3 (p = 0.018). Finally, adding LGE-PPM involvement on top of the model included TTE LVEF<35% plus DERIVATE-ICM Risk Score quartiles Q2-Q3 provided a significant improvement of prognostic stratification (p = 0.044).
CONCLUSION: This study suggests that, in a wide population of ICM patients, LGE-PPM is independently associated with the occurrence of MAACE. In the intermediate quartiles of the DERIVATE-ICM Risk Score, the absence of LGE-PPM, when added to the Score, may contribute to downward re-stratification of arrhythmic risk.
CLINICAL TRIAL REGISTRATION: RCT#NCT03352648.