CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: an international Registry. Issue 7 (1st April 2021)

• Record Type: Journal Article
• Authors: Guaricci, Andrea Igoren; Masci, Pier Giorgio; Muscogiuri, Giuseppe; Guglielmo, Marco; Baggiano, Andrea; Fusini, Laura; Lorenzoni, Valentina; Martini, Chiara; Andreini, Daniele; Pavon, Anna Giulia; Aquaro, Giovanni D; Barison, Andrea; Todiere, Giancarlo; Rabbat, Mark G; Tat, Emily; Raineri, Claudia; Valentini, Adele; Varga-Szemes, Akos; Schoepf, U. Joseph; De Cecco, Carlo N; Bogaert, Jan; Dobrovie, Monica; Symons, Rolf; Focardi, Marta; Gismondi, Annalaura; Lozano-Torres, Jordi; Rodriguez-Palomares, Josè F; Lanzillo, Chiara; Di Roma, Mauro; Moro, Claudio; Di Giovine, Gabriella; Margonato, Davide; De Lazzari, Manuel; Perazzolo Marra, Martina; Nese, Alberto; Casavecchia, Grazia; Gravina, Matteo; Marzo, Francesca; Carigi, Samuela; Pica, Silvia; Lombardi, Massimo; Censi, Stefano; Squeri, Angelo; Palumbo, Alessandro; Gaibazzi, Nicola; Camastra, Giovanni; Sbarbati, Stefano; Pedrotti, Patrizia; Masi, Ambra; Carrabba, Nazario; Pradella, Silvia; Timpani, Mauro; Cicala, Gloria; Presicci, Cristina; Puglisi, Sara; Sverzellati, Nicola; Santobuono, Vincenzo Ezio; Pepi, Mauro; Schwitter, Juerg; Pontone, Gianluca;
• Is Part Of: Europace. Volume 23:Issue 7(2021)
• Page Start: 1072
• Page End: 1083
• Publication Date: 2021-04-01
• Subjects: Non-ischaemic dilated cardiomyopathy -- Heart failure -- Implantable cardioverter-defibrillator -- Cardiac magnetic resonance -- Primary prevention; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euaa401
• Languages: English
• ISSNs: 1099-5129

Abstract

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.