Stolfo Davide, Albani Stefano, Savarese Gianluigi, Barbati Giulia, Ramani Federica, Gigli Marta, Biondi Federico, Dal Ferro Matteo, Zecchin Massimo, Merlo Marco, Sinagra Gianfranco
Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy.
Int J Cardiol. 2020 May 15;307:75-81. doi: 10.1016/j.ijcard.2020.02.025. Epub 2020 Feb 11.
Primary prevention implantable cardioverter defibrillator (ICD) is not generally recommended in New York Heart Association (NYHA) I class patients with dilated cardiomyopathy (DCM). This study sought to assess the competing risk of sudden cardiac death (SCD) in DCM patients with left ventricular ejection fraction (EF) ≤35% and NYHA I class.
A total of 272 DCM patients with EF ≤35% and NYHA class I-III after ≥3 months of guideline-directed medical therapy were included. The risk of SCD and SCD/malignant ventricular arrhythmias (MVA) was assessed in NYHA I vs. NYHA II and NYHA III groups by competing risk analysis.
NYHA I patients were younger, had higher EF and smaller left atrium, were less likely receiving mineral corticoid receptor antagonists. The cumulative incidence of SCD (p = 0.92) and SCD/MVA (p = 0.42) did not differ between NYHA I vs NYHA II-III classes. NYHA class did not influence the association between ICD and SCD risk (p for interaction = 0.125).
In this cohort of DCMs, patients with EF ≤35% and NYHA I class were exposed to a risk of SCD and life-threatening arrhythmias not different from NYHA II-III. Therefore, inclusion of asymptomatic patients with DCM and systolic dysfunction should be strongly considered in future randomized studies on primary prevention ICD.
对于纽约心脏协会（NYHA）心功能I级的扩张型心肌病（DCM）患者，一般不建议植入一级预防型植入式心脏复律除颤器（ICD）。本研究旨在评估左心室射血分数（EF）≤35%且NYHA心功能I级的DCM患者心源性猝死（SCD）的竞争风险。
纳入272例经≥3个月指南指导药物治疗后EF≤35%且NYHA心功能I - III级的DCM患者。通过竞争风险分析评估NYHA心功能I级与II级和III级患者中SCD及SCD/恶性室性心律失常（MVA）的风险。
NYHA心功能I级患者更年轻，EF更高，左心房更小，接受盐皮质激素受体拮抗剂的可能性更小。NYHA心功能I级与II - III级患者之间SCD（p = 0.92）和SCD/MVA（p = 0.42）的累积发生率无差异。NYHA心功能分级不影响ICD与SCD风险之间的关联（交互作用p = 0.125）。
在这个DCM队列中，EF≤35%且NYHA心功能I级的患者发生SCD和危及生命心律失常的风险与NYHA心功能II - III级患者无异。因此，在未来关于一级预防ICD的随机研究中，应强烈考虑纳入无症状的DCM和收缩功能障碍患者。
