Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Cardiology, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany.
ESC Heart Fail. 2020 Aug;7(4):1430-1441. doi: 10.1002/ehf2.12689. Epub 2020 Apr 14.
Patients with non-ischaemic dilated cardiomyopathy (DCM) are at increased risk of sudden cardiac death. Identification of patients that may benefit from implantable cardioverter-defibrillator implantation remains challenging. In this study, we aimed to determine predictors of sustained ventricular arrhythmias in patients with DCM.
We searched MEDLINE/Embase for studies describing predictors of sustained ventricular arrhythmias in patients with DCM. Quality and bias were assessed using the Quality in Prognostic Studies tool, articles with high risk of bias in ≥2 areas were excluded. Unadjusted hazard ratios (HRs) of uniformly defined predictors were pooled, while all other predictors were evaluated in a systematic review. We included 55 studies (11 451 patients and 3.7 ± 2.3 years follow-up). Crude annual event rate was 4.5%. Younger age [HR 0.82; 95% CI (0.74-1.00)], hypertension [HR 1.95; 95% CI (1.26-3.00)], prior sustained ventricular arrhythmia [HR 4.15; 95% CI (1.32-13.02)], left ventricular ejection fraction on ultrasound [HR 1.45; 95% CI (1.19-1.78)], left ventricular dilatation (HR 1.10), and presence of late gadolinium enhancement [HR 5.55; 95% CI (4.02-7.67)] were associated with arrhythmic outcome in pooled analyses. Prior non-sustained ventricular arrhythmia and several genotypes [mutations in Phospholamban (PLN), Lamin A/C (LMNA), and Filamin-C (FLNC)] were associated with arrhythmic outcome in non-pooled analyses. Quality of evidence was moderate, and heterogeneity among studies was moderate to high.
In patients with DCM, the annual event rate of sustained ventricular arrhythmias is approximately 4.5%. This risk is considerably higher in younger patients with hypertension, prior (non-)sustained ventricular arrhythmia, decreased left ventricular ejection fraction, left ventricular dilatation, late gadolinium enhancement, and genetic mutations (PLN, LMNA, and FLNC). These results may help determine appropriate candidates for implantable cardioverter-defibrillator implantation.
非缺血性扩张型心肌病（DCM）患者发生心源性猝死的风险增加。确定哪些患者可能从植入式心脏复律除颤器（ICD）植入中获益仍然具有挑战性。本研究旨在确定 DCM 患者持续性室性心律失常的预测因素。
我们在 MEDLINE/Embase 中检索了描述 DCM 患者持续性室性心律失常预测因素的研究。使用预后研究质量工具（Quality in Prognostic Studies tool）评估质量和偏倚，对≥2 个领域存在高偏倚风险的文章进行排除。汇总了统一定义的预测因素的未调整危险比（HR），而其他所有预测因素均在系统评价中进行评估。我们纳入了 55 项研究（11451 例患者，随访 3.7±2.3 年）。未调整的年化事件发生率为 4.5%。较年轻的年龄[HR 0.82；95%可信区间（CI）（0.74-1.00)]、高血压[HR 1.95；95%CI（1.26-3.00)]、既往持续性室性心律失常[HR 4.15；95%CI（1.32-13.02)]、超声心动图检查的左心室射血分数[HR 1.45；95%CI（1.19-1.78)]、左心室扩张[HR 1.10]和存在晚期钆增强[HR 5.55；95%CI（4.02-7.67)]与汇总分析中的心律失常结局相关。既往非持续性室性心律失常和几种基因型[Phospholamban（PLN）、Lamin A/C（LMNA）和Filamin-C（FLNC）突变]与非汇总分析中的心律失常结局相关。证据质量为中等，研究间异质性为中至高。
在 DCM 患者中，持续性室性心律失常的年化事件发生率约为 4.5%。患有高血压、既往（非）持续性室性心律失常、左心室射血分数降低、左心室扩张、晚期钆增强和基因突变（PLN、LMNA 和 FLNC）的年轻患者发生这种风险的可能性显著更高。这些结果可能有助于确定适合植入式心脏复律除颤器植入的合适患者。
