Arrhythmic Risk Stratification According to LGE Corridors and Genetics in Nonischemic Dilated Cardiomyopathy.
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Ramos-López Noemí, Mora-Ayestarán Nerea, Ochoa Juan Pablo, Claver Eduard, Gómez González Cristina, Poel Edwin, García Monsalvo Mónica, Casas Guillem, Muñoz-Esparza Carmen, Basurte-Elorz María Teresa, Larrañaga-Moreira José M, García-Pinilla Jose M, Mogollón Jiménez María Victoria, Cabezón Villalba Gonzalo, Espejo Bares Victoria, Ruiz-Cueto María, López-Abel Bernardo, García-Álvarez Ana, Climent-Payá Vicente, Tirón Coloma, Cabrera-Borrego Eva, Peña-Peña María Luisa, Ripoll-Vera Tomas, Zorio Esther, Sanaú Javier, Rodríguez González Elena, Bezzina Connie R, Gallego Delgado María, Rodríguez-Palomares José F, di Marco Andrea, Espinosa Castro María Ángeles, Amin Ahmad S, Garcia-Pavia Pablo, Mirelis Jesús G
Аннотация
METHODS: We studied consecutive patients with nonischemic dilated cardiomyopathy from 22 European centers who had undergone genetic testing and cardiac magnetic resonance imaging.
RESULTS: Among 925 patients (mean age, 54.5 years [interquartile range, 43.7-63.9 years]; 64% men; mean left ventricular ejection fraction, 37.6% [26.9%-44.8%]; LGE in 24.3%), LGE corridors were present in 160 patients (17.3%), and HRG in 119 (12.9%). After a median follow-up of 5.4 years (interquartile range, 3.3-7.7), 95 patients (10.3%) experienced an MVA. In multivariable competing-risk analysis adjusted for left ventricular ejection fraction and extent of LGE, the number of LGE corridors and HRGs were independently associated with MVA (subdistribution hazard ratio, 1.25 [95% CI, 1.11-1.42]; P<0.001; and subdistribution hazard ratio, 2.28 [95% CI, 1.32-3.96]; P=0.003, respectively). An optimal cutoff of ≥4 LGE corridors predicted MVA. A stepwise risk stratification algorithm to predict MVA integrating LGE, the presence of ≥4 LGE corridors, and HRG outperformed left ventricular ejection fraction ≤35%-based classification proposed in guidelines (5-year time-dependent area under the curve, 0.72 [95% CI, 0.65-0.78] versus 0.57 [95% CI, 0.51-0.64]; P=0.001), showing a progressive increase in arrhythmic risk across categories (Gray test P<0.001), and allowing clinically meaningful arrhythmic risk classification.
CONCLUSIONS: LGE corridors and HRGs provide additive value for arrhythmic risk stratification in patients with nonischemic dilated cardiomyopathy. These findings support MVA multiparametric prediction over the traditional left ventricular ejection fraction ≤35% threshold.