Redefining the risk of major arrhythmic events in non-ischaemic cardiomyopathy: insights from the DERIVATE-NICM study.
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Guaricci Andrea Igoren, Carrabba Nazario, Romano Salvatore Mario, Chiostri Marco, Fusini Laura, Baggiano Andrea, Mushtaq Saima, Volpe Alessandra, Abete Raffaele, Aquaro Giovanni Donato, Barison Andrea, Basile Paolo, Bogaert Jan, Calo' Leonardo, Camastra Giovanni, Carigi Samuela, Casavecchia Grazia, Censi Stefano, Cicala Gloria, Ciccone Marco Matteo, De Cecco Carlo N, 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, Muscogiuri Giuseppe, Nese Alberto, Palumbo Alessandro, Pavon Anna Giulia, Pedrotti Patrizia, Perazzolo Marra Martina, Pradella Silvia, Presicci Cristina, Rabbat Mark G, Raineri Claudia, Rodriguez-Palomares Jose' F, Casas Guillem, Rodenas-Alesina Eduardo, Giustiniani Alessandro, Sbarbati Stefano, Schoepf U Joseph, Squeri Angelo, Sverzellati Nicola, Symons Rolf, Tat Emily, Timpani Mauro, Todiere Giancarlo, Valentini Adele, Varga-Szemes Akos, Schwitter Juerg, Pontone Gianluca
Аннотация
METHODS AND RESULTS: One thousand three hundred and eighty-four NICM patients with chronic heart failure and left ventricular ejection fraction (LVEF) < 50% were evaluated for primary sudden cardiac death prevention therapy. Major adverse arrhythmic cardiac events (MAACEs) were the primary endpoint. During a median follow-up of 959 days, MAACE occurred in 128 (9.2%) patients. In the multivariate analyses, male gender [hazard ratio (HR): 1.605 (95% confidence interval, CI: 1.051-2.451); P = 0.028], LVEF per point % [HR: 0.977 (95% CI: 0.961-0.993); P = 0.005] and presence and location of midwall LGE [weighted HR: 1.066 (95% CI: 1.045-1.086), P < 0.001] were independent predictors of MAACE. A multi-parametric CMR-weighted predictive-derived score (DERIVATE Risk Score 2.0) provided a higher additional prognostic value vs. transthoracic echocardiography-LVEF cut-off of 35% when compared with the previous published DERIVATE Risk Score 1.0 with a net reclassification improvement of 54.52% (95% CI: 36.52-72.52%; P < 0.001). These findings were confirmed in the validation cohort.
CONCLUSION: The presence of midwall LGE, but also the location of scar, confers an added and independent MAACE risk to a large NICM population influencing the choice of treatment.