Journal of the American Society of Echocardiography
Clinical InvestigationsLongitudinal Relationship Between Left Ventricular Ejection Fraction and Risk For Ventricular Arrhythmia in Nonischemic Dilated CardiomyopathyLongitudinal Arrhythmic Risk Assessment Based on Ejection Fraction in Patients with Recent-Onset Nonischemic Dilated Cardiomyopathy
Graphical abstract
Section snippets
Study Population and Design
All patients with DCM consecutively enrolled in the Heart Muscle Disease Registry (HMDR) of Trieste between January 1, 1993, and December 31, 2017, were retrospectively reviewed. The HMDR has been previously described.6 The registry defines DCM as the presence of left ventricular (LV) systolic dysfunction (LVEF ≤ 50%) in the absence of either pressure or volume overload or significant coronary artery disease.7 Coronary angiography or coronary computed tomography is performed in patients
Phase 1: Risk for Major Arrhythmic Events during the First 2 Years of GDMT
Among 1,207 patients with DCM consecutively enrolled in the HMDR of Trieste during the study period, 544 met the inclusion criteria and had echocardiographic data available at enrollment, 355 (65%) had echocardiographic data collected at the 6-month evaluation (median, 5 months; interquartile range, 3-6 months), and 403 (73%) had echocardiographic data collected at the 24-month evaluation (median, 24 months; interquartile range, 19-28 months). Data from all these patients were included in the
Discussion
We provide for the first time a longitudinal assessment of arrhythmic risk in a large and well-characterized cohort of patients with recent-onset nonischemic DCM treated with GDMT. We found that (1) before 24 months, the occurrence of MVAs or SCD in patients with DCM is rare and is not associated with LVEF ≤ 35%, but conversely, after 2 years of GDMT, LVEF ≤ 35% portends a higher arrhythmic risk during follow-up (Figures 2 and 3); (2) a high proportion of patients (>60%) have improved LVEFs (to
Conclusion
In response to GDMT, patients with DCM experience LVRR and improvement in LVEF for up to 2 years. Arrhythmic risk stratification on the basis of a single measurement of LVEF soon after the initiation of GDMT is therefore not effective in this patient population. We found that LVEF ≤ 35% becomes a valuable single parameter to stratify arrhythmic risk for patients with DCM after 2 years of GDMT. We also found that in unselected patients with DCM, the risk for adverse arrhythmic events is low
Acknowledgments
We would like to thank Fondazione CRTrieste, Fondazione CariGO, Fincantieri, and all the health care professionals of Azienda Sanitaria Universitaria Giuliano Isontina for their continuous support of the clinical management of patients affected by cardiomyopathies within the Heart Failure Outpatient Clinic of Trieste.
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Drs. De Angelis and Merlo share first authorship.
Drs. Adamo and Sinagra share last authorship.
Drs. Merlo and Sinagra are Members of ERN GUARD-HEART (European Reference Network for Rare and Complex Diseases of the Heart; http://guardheart.ern-net.eu).
Dr. Adamo was supported by National Institutes of Health grant 1K08HL145108-01A1.
Conflicts of Interest: None.