Left ventricular non-compaction cardiomyopathy: additional predictors of life-threatening events for selecting patients for cardioverter defibrillator implantation
Abstract
The aim of the study is to determine
predictors of life-threatening arrhythmic events in order to identify high-risk
patients requiring ICD/CRT-D implantation.
Material and methods. The study included 155 patients with left ventricular non-compaction
cardiomyopathy (NCCM), 59 (38.1%) women, 96 (61.9%) men, and a median age of 39
(28; 51) years. In addition to the standard examination, cardiac magnetic
resonance (CMR) imaging with late gadolinium enhancement (LGE) was performed.
The median follow-up was 36 months (6; 152).
Endpoints of the study included life-threatening
arrhythmic events (sustained VT/VF) requiring device implantation (ICD/CRT-D).
Results. During the follow-up period, life - threatening arrhythmic events
(sustained VT/VF) developed in 15 patients, of which ICD - 8 and CRT-D - 7 were
implanted as part of the secondary prevention of sudden cardiac death (SCD).
The 3-year event-free survival rate was 88±14%. In multivariate analysis,
independent factors associated with the risk of life-threatening events
requiring ICD/CT-D implantation are the following characteristics: the presence
of syncope (HR 12.5; 95% CI 3.9-39.7, p<0.001),
the presence of nonsustained VT (HR 11.8; 95% CI 1.5-95.1, p<0.021) and the percentage of fibrosis volume ≥30% (HR
3.23; 95% CI 1.01-10.4, p<0.048).
Risk groups of life-threatening events were stratified based on multi-factor
analysis. The three-year event-free survival rate of the high-risk group
was 77.8±5.8%, the low-risk group had no adverse events during the entire
follow-up period, and the three-year event-free survival rate was 100%.
Conclusion. The developed model of risk stratification of life-threatening events
allows identifying high-risk patients for timely preventive measures.
Keywords:non-compaction cardiomyopathy, predictors of life-threatening arrhythmic events, cardiac magnetic resonance, late gadolinium enhancement
Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
For citation: Komissarova S.M., Krasko O.V., Rineiska N.M.,
Haidzel I.K. Left ventricular non-compaction cardiomyopathy: additional
predictors of life-threatening events for selecting patients for cardioverter
defibrillator implantation. Clinical and Experimental Surgery. Petrovsky
Journal. 2020; 8 (3): 73-8. DOI: https://doi.org/10.33029/2308-1198-2020-8-3-73-78 (in Russian)
References
1. Arbustini E., Weidemann F., Hall J. Left ventricular noncompaction: a distinct cardiomyopathy or a trait shared by different cardiac diseases? J Am Coll Cardiol. 2014; 64: 1840-50. DOI: https://doi.org/10.1016/j.jacc.2014.08.030
2. Oechslin E., Attenhofer Jost C., Rojas J., et al. Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol. 2000; 36 (2): 493-500. DOI: https://doi.org/10.1016/s0735-1097(00)00755-5
3. Finsterer J. Cardiogenetics, neurogenetics, and pathogenetics of left ventricular hypertrabeculation/ noncompaction. Pediatr Cardiol 2009; 30: 659-81. DOI: https://doi.org/10.1007/s00246-008-9359-0
4. Towbin J., Lorts A., Jefferies J. Left ventricular noncompaction cardiomyopathy. Lancet, 2015; 386: 813-25. DOI: https://doi.org/10.1016/S0140-6736(14)61282-4
5. Kayvanpour E., Sedaghat-Hamedani F., Gi W., et al. Clinical and genetic insights into non-compaction: a meta-analysis and systematic review on 7598 individuals. Clin Res Cardiol. 2019; 108 (11): 1297-308. DOI: https://doi.org/10.1007/s00392-019-01465-3
6. Haugaa K., Dan G., Iliodromitis K. Management of patients with ventricular arrhythmias and prevention of sudden cardiac death-translating guidelines into practice: results of the European Heart Rhythm Association survey. Europace. 2018; 20: f249-53. DOI: https://doi.org/10.1093/europace/euy112
7. Towbin J., McKenna W., Abrams D. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. HeartRhythm. 2019; 16(11): e301-72. DOI: https://doi.org/10.1016/j.hrthm.2019.05.007
8. Andreini D., Pontone G., Bogaert J., et al. Longterm prognostic value of cardiac magnetic resonance in left ventricle noncompaction. J Am Coll Cardiol. 2016; 68 (20): 2166-81. DOI: https://doi.org/10.1016/j.jacc.2016.08.053
9. Jenni R., Oechslin E., Schneider J., et al. Echocar-diographic and pathoanatomical characteristics of isolated left ventricular non-compaction: a step towards classification as a distinct cardiomyopathy. Heart. 2001; 86 (6): 666-71. DOI: https://doi.org/10.1136/heart.86.6.666
10. Petersen S., Selvanayagam J., Wiesmann F., et al. Left ventricular non-compaction: in-sights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol. 2005; 46 (1): 101-5. DOI: https://doi.org/10.1016/j.jacc.2005.03.045
11. Jacquier A., Thuny F., Jop B., et al. Measurement of trabeculated left ventricular mass using cardiac magnetic resonance imaging in the diagnosis of left ventricular non-compaction. Eur Heart J. 2010; 31 (9): 1098-104. DOI: https://doi.org/10.1093/eurheartj/ehp595
12. Lausen B., Hothorn T., Bretz F., et al. Assessment of optimal selected prognostic factors. Biometrical J. 2004; 46 (3): 364 - 74.
13. Mavrogeni S., Sfendouraki E., Theodorakis G., et al. Diagnosis, severity grading and prognosis of left ventricular non-compaction using cardiovascular magnetic resonance. Int J Cardiol. 2012; 167: 598-9. DOI: https://doi.org/10.1016/j.ijcard.2012.09.234
14. Ashrith G., Gupta D., Hanmer J., et al. Cardiovascular magnetic resonance characterization of left ventricular non-compaction provides independent prognostic information in patients with incident heart failure or suspected cardiomyopathy. J Cardiovasc Magn Reson. 2014; 16: 64. DOI: https://doi.org/10.1186/s12968-014-0064-2