Heart rhythm · 2025
Prognostic impact of atrio-ventricular conduction abnormalities in non-ischemic cardiomyopathy.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Sanaú Javier, Di Marco Andrea, Brown Pamela, de Frutos Fernando, Bermeo Juan Andrés, Rodriguez García Julian, Nucifora Gaetano, Claver Eduard, Bradley Joshua, Gonzalez Lopera Marta, Miller Christopher A, Jovells Silvia, Gomez-Hospital Joan Antoni, Comín-Colet Josep, Anguera Ignasi, Schmitt Matthias
Аннотация
BACKGROUND: Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) improves prediction of ventricular arrhythmias (VA) in non-ischemic cardiomyopathy (NICM), but risk stratification within LGE+ cases remains challenging. Atrioventricular block (AVB) has been proposed as a predictor of VA, but contemporary data are scarce.
OBJECTIVE: To assess the prognostic value of AVB in a contemporary cohort of patients with NICM studied with CMR.
METHODS: Retrospective cohort study including 616 patients with NICM, with assessment of AVB at electrocardiogram (ECG) and LGE at CMR. The primary arrhythmic end point included any appropriate implantable cardioverter defibrillator therapy, sustained monomorphic ventricular tachycardia, resuscitated cardiac arrest, and sudden death. The secondary heart failure (HF) end point included HF hospitalization, heart transplant, left ventricular assist device implant, and death due to end-stage HF.
RESULTS: AVB was observed in 9% of patients and was associated with more severe cardiac dysfunction (left ventricular ejection fraction [LVEF] 29% vs 37%, P < .001) and higher prevalence of LGE (63% vs 46%, P = .02). AVB independently predicted the combined arrhythmic end point in addition to LGE and LVEF (hazard ratio [HR], 2.7; P = .007), and was particularly impactful when present alongside LGE; among LGE+ patients, AVB significantly increased the risk of the primary end point (adjusted HR 3.4, P < .001). In contrast, AV block was not a significant predictor of the HF end point at multivariate analysis (P = .11).
CONCLUSION: AVB is a strong and independent predictor of VA and sudden death in NICM, in addition to LGE and LVEF. In addition, AVB has a significant impact on the risk stratification of LGE+ cases, identifying a small sub-group of patients with extremely high arrhythmic risk.
OBJECTIVE: To assess the prognostic value of AVB in a contemporary cohort of patients with NICM studied with CMR.
METHODS: Retrospective cohort study including 616 patients with NICM, with assessment of AVB at electrocardiogram (ECG) and LGE at CMR. The primary arrhythmic end point included any appropriate implantable cardioverter defibrillator therapy, sustained monomorphic ventricular tachycardia, resuscitated cardiac arrest, and sudden death. The secondary heart failure (HF) end point included HF hospitalization, heart transplant, left ventricular assist device implant, and death due to end-stage HF.
RESULTS: AVB was observed in 9% of patients and was associated with more severe cardiac dysfunction (left ventricular ejection fraction [LVEF] 29% vs 37%, P < .001) and higher prevalence of LGE (63% vs 46%, P = .02). AVB independently predicted the combined arrhythmic end point in addition to LGE and LVEF (hazard ratio [HR], 2.7; P = .007), and was particularly impactful when present alongside LGE; among LGE+ patients, AVB significantly increased the risk of the primary end point (adjusted HR 3.4, P < .001). In contrast, AV block was not a significant predictor of the HF end point at multivariate analysis (P = .11).
CONCLUSION: AVB is a strong and independent predictor of VA and sudden death in NICM, in addition to LGE and LVEF. In addition, AVB has a significant impact on the risk stratification of LGE+ cases, identifying a small sub-group of patients with extremely high arrhythmic risk.