CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: An international Registry

Andrea Igoren Guaricci, Pier Giorgio Masci, Giuseppe Muscogiuri, Marco Guglielmo, Andrea Baggiano, Laura Fusini, Valentina Lorenzoni, Chiara Martini, Daniele Andreini, Anna Giulia Pavon, Giovanni D. Aquaro, Andrea Barison, Giancarlo Todiere, Mark G. Rabbat, Emily Tat, Claudia Raineri, Adele Valentini, Akos Varga-Szemes, U. Joseph Schoepf, Carlo N. De CeccoJan Bogaert, Monica Dobrovie, Rolf Symons, Marta Focardi, Annalaura Gismondi, Jordi Lozano-Torres, Josè F. Rodriguez-Palomares, Chiara Lanzillo, Mauro Di Roma, Claudio Moro, Gabriella Di Giovine, Davide Margonato, Manuel De Lazzari, Martina Perazzolo Marra, Alberto Nese, Grazia Casavecchia, Matteo Gravina, Francesca Marzo, Samuela Carigi, Silvia Pica, Massimo Lombardi, Stefano Censi, Angelo Squeri, Alessandro Palumbo, Nicola Gaibazzi, Giovanni Camastra, Stefano Sbarbati, Patrizia Pedrotti, Ambra Masi, Nazario Carrabba, Silvia Pradella, Mauro Timpani, Gloria Cicala, Cristina Presicci, Sara Puglisi, Nicola Sverzellati, Vincenzo Ezio Santobuono, Mauro Pepi, Juerg Schwitter, Gianluca Pontone

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)1072-1083
Number of pages12
JournalEuropace
Volume23
Issue number7
DOIs
Publication statusPublished - Jul 1 2021

Keywords

  • Cardiac magnetic resonance
  • Heart failure
  • Implantable cardioverter-defibrillator
  • Non-ischaemic dilated cardiomyopathy
  • Primary prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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