Kiang Alan, Al-Deiri Danah, Ming Wang Tom Kai, Nezafat Reza, Rizkallah Diane, Callahan Thomas D, Lee Justin Z, Santangeli Pasquale, Wazni Oussama M, Varma Niraj, Nguyen Christopher, Sroubek Jakub, Kwon Deborah
Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Cardiovascular Medicine, Section of Cardiovascular Imaging, Cleveland Clinic Foundation, Cleveland, Ohio.
Heart Rhythm. 2025 Jan 10. doi: 10.1016/j.hrthm.2025.01.003.
Better risk stratification is needed to evaluate patients with nonischemic cardiomyopathy (NICM) for prophylactic implantable cardioverter-defibrillators (ICDs). Growing evidence suggests that cardiac magnetic resonance (CMR) imaging may be useful in this regard.
We aimed to determine if late gadolinium enhancement (LGE) seen on CMR (dichotomized as none or minimal <2% vs significant ≥2%) predicts appropriate ICD therapies (primary endpoint) or all-cause mortality/transplant/left-ventricular assist device (LVAD) implantation (secondary endpoint) in patients with NICM.
We identified 344 patients with NICM who underwent primary prevention ICD implantation at Cleveland Clinic between 2003 and 2021 with CMR within 12 months before implant. LGE was calculated as percentage myocardium with pixel intensity ≥5 standard deviations higher than that of reference myocardium. Endpoints were adjudicated retrospectively by chart review.
A total of 125 of 344 patients (36%) had none or minimal LGE, and 219 (64%) had significant LGE. Over a median follow-up of 61 months, 53 patients (24%) with significant LGE vs 10 (8%) with none or minimal LGE met the primary endpoint, and 56 patients (26%) vs 21 (17%) met the secondary endpoint, respectively. Significant LGE predicted the primary outcome in multivariable competing-risks regression (hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.48-6.02, P = .002), but did not predict the secondary outcome in multivariable Cox regression (HR 1.34, 95% CI 0.78-2.29, P = .287).
In patients with NICM and primary prevention ICDs, LGE ≥2% is predictive of appropriate device therapies but not all-cause mortality/LVAD/transplant. LGE may be a relatively specific predictor of sudden cardiac arrest risk and therefore could potentially be used during evaluation for prophylactic ICD implantation.
对于非缺血性心肌病（NICM）患者进行预防性植入式心律转复除颤器（ICD）评估时，需要更好的风险分层。越来越多的证据表明，心脏磁共振（CMR）成像在这方面可能有用。
我们旨在确定CMR上所见的延迟钆增强（LGE，分为无或轻度<2%与显著≥2%）是否能预测NICM患者的适当ICD治疗（主要终点）或全因死亡率/移植/左心室辅助装置（LVAD）植入（次要终点）。
我们确定了344例在2003年至2021年期间于克利夫兰诊所接受一级预防ICD植入且在植入前12个月内进行CMR检查的NICM患者。LGE计算为像素强度比参考心肌高≥5个标准差的心肌百分比。通过病历回顾对终点进行回顾性判定。
344例患者中共有125例（36%）无或轻度LGE，219例（64%）有显著LGE。在中位随访61个月期间，有显著LGE的53例患者（24%）与无或轻度LGE的10例患者（8%）达到主要终点，分别有56例患者（26%）与21例患者（17%）达到次要终点。显著LGE在多变量竞争风险回归中预测主要结局（风险比[HR]2.99，95%置信区间[CI]1.48 - 6.02，P = 0.002），但在多变量Cox回归中未预测次要结局（HR 1.34，95% CI 0.78 - 2.29，P = 0.287）。
在接受一级预防ICD的NICM患者中，LGE≥2%可预测适当的器械治疗，但不能预测全因死亡率/LVAD/移植。LGE可能是心脏骤停风险的相对特异性预测指标，因此在预防性ICD植入评估期间可能有潜在用途。
