CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: an international Registry. Journal Article


Authors: Guaricci, AI; Masci, PG; Muscogiuri, G; Guglielmo, M; Baggiano, A; Fusini, L; Lorenzoni, V; Martini, C; Andreini, D; Pavon, AG; Aquaro, GD; Barison, A; Todiere, G; Rabbat, MG; Tat, E; Raineri, C; Valentini, A; Varga-Szemes, A; Schoepf, UJ; De Cecco, CN; Bogaert, J; Dobrovie, M; Symons, R; Focardi, M; Gismondi, A; Lozano-Torres, J; Rodriguez-Palomares, JF; Lanzillo, C; Di Roma, M; Moro, C; Di Giovine, G; Margonato, D; De Lazzari, M; Perazzolo Marra, M; Nese, A; Casavecchia, G; Gravina, M; Marzo, F; Carigi, S; Pica, S; Lombardi, M; Censi, S; Squeri, A; Palumbo, A; Gaibazzi, N; Camastra, G; Sbarbati, S; Pedrotti, P; Masi, A; Carrabba, N; Pradella, S; Timpani, M; Cicala, G; Presicci, C; Puglisi, S; Sverzellati, N; Santobuono, VE; Pepi, M; Schwitter, J; Pontone, G
Article Title: CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: an international Registry.
Abstract: AIMS: The aim of this registry was to evaluate the additional prognostic value of a composite cardiac magnetic resonance (CMR)-based risk score over standard-of-care (SOC) evaluation in a large cohort of consecutive unselected non-ischaemic cardiomyopathy (NICM) patients. METHODS AND RESULTS: In the DERIVATE registry (www.clinicaltrials.gov/registration: RCT#NCT03352648), 1000 (derivation cohort) and 508 (validation cohort) NICM patients with chronic heart failure (HF) and left ventricular ejection fraction 50% were included. All-cause mortality and major adverse arrhythmic cardiac events (MAACE) were the primary and secondary endpoints, respectively. During a median follow-up of 959?days, all-cause mortality and MAACE occurred in 72 (7%) and 93 (9%) patients, respectively. Age and >3 segments with midwall fibrosis on late gadolinium enhancement (LGE) were the only independent predictors of all-cause mortality (HR: 1.036, 95% CI: 1.0117-1.056, P?0.001 and HR: 2.077, 95% CI: 1.211-3.562, P?=?0.008, respectively). For MAACE, the independent predictors were male gender, left ventricular end-diastolic volume index by CMR (CMR-LVEDVi), and >3 segments with midwall fibrosis on LGE (HR: 2.131, 95% CI: 1.231-3.690, P?=?0.007; HR: 3.161, 95% CI: 1.750-5.709, P?0.001; and HR: 1.693, 95% CI: 1.084-2.644, P?=?0.021, respectively). A composite clinical and CMR-based risk score provided a net reclassification improvement of 63.7% (P?0.001) for MAACE occurrence when added to the model based on SOC evaluation. These findings were confirmed in the validation cohort. CONCLUSION: In a large multicentre, multivendor cohort registry reflecting daily clinical practice in NICM work-up, a composite clinical and CMR-based risk score provides incremental prognostic value beyond SOC evaluation, which may have impact on the indication of implantable cardioverter-defibrillator implantation.
Journal Title: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ISSN: 1532-2092; 1099-5129
Publisher: Oxford Journals  
Date Published: 2021