Details

Autor(en) / Beteiligte

• Perazzolo Marra, Martina, MD, PhD
• De Lazzari, Manuel, MD
• Zorzi, Alessandro, MD
• Migliore, Federico, MD, PhD
• Zilio, Filippo, MD
• Calore, Chiara, MD, PhD
• Vettor, Giulia, MD
• Tona, Francesco, MD, PhD
• Tarantini, Giuseppe, MD, PhD
• Cacciavillani, Luisa, MD, PhD
• Corbetti, Francesco, MD
• Giorgi, Benedetta, MD
• Miotto, Diego, MD
• Thiene, Gaetano, MD
• Basso, Cristina, MD, PhD
• Iliceto, Sabino, MD
• Corrado, Domenico, MD, PhD

Titel

Impact of the presence and amount of myocardial fibrosis by cardiac magnetic resonance on arrhythmic outcome and sudden cardiac death in nonischemic dilated cardiomyopathy

Ist Teil von

• Heart rhythm, 2014-05, Vol.11 (5), p.856-863

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2014

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• Background Current risk stratification for sudden cardiac death (SCD) in nonischemic dilated cardiomyopathy (NIDC) relies on left ventricular (LV) dysfunction, a poor marker of ventricular electrical instability. Contrast-enhanced cardiac magnetic resonance has the ability to accurately identify and quantify ventricular myocardial fibrosis (late gadolinium enhancement [LGE]). Objective To evaluate the impact of the presence and amount of myocardial fibrosis on arrhythmogenic risk prediction in NIDC. Methods One hundred thirty-seven consecutive patients with angiographically proven NIDC were enrolled for this study. All patients were followed up for a combined arrhythmic end point including sustained ventricular tachycardia (VT), appropriate implantable cardioverter-defibrillator (ICD) intervention, ventricular fibrillation (VF), and SCD. Results LV-LGE was identified in 76 (55.5%) patients. During a median follow-up of 3 years, the combined arrhythmic end point occurred in 22 (16.1%) patients: 8 (5.8%) sustained VT, 9 (6.6%) appropriate ICD intervention, either against VF (n = 5; 3.6%) or VT (n = 4; 2.9%), 3 (2.2%) aborted SCD, and 2 (1.5%) died suddenly. Kaplan-Meier analysis revealed a significant correlation between the LV-LGE presence (not the amount and distribution) and malignant arrhythmic events ( P < .001). In univariate Cox regression analysis, LV-LGE (hazard ratio [HR] 4.17; 95% confidence interval [CI] 1.56–11.2; P = .005) and left bundle branch block (HR 2.43; 95% CI 1.01–5.41; P = .048) were found to be associated with arrhythmias. In multivariable analysis, the presence of LGE was the only independent predictor of arrhythmias (HR 3.8; 95% CI 1.3–10.4; P = .01). Conclusions LV-LGE is a powerful and independent predictor of malignant arrhythmic prognosis, while its amount and distribution do not provide additional prognostic value. Contrast-enhanced cardiac magnetic resonance may contribute to identify candidates for ICD therapy not fulfilling the current criteria based on left ventricular ejection fraction.