CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: an international Registry

Guaricci, A. I.; Masci, P. G.; Muscogiuri, G.; Guglielmo, M.; Baggiano, A.; Fusini, L.; Lorenzoni, V.; Martini, C.; Andreini, D.; Pavon, A. G.; Aquaro, G. D.; Barison, A.; Todiere, G.; Rabbat, M. G.; Tat, E.; Raineri, C.; Valentini, A.; Varga-Szemes, A.; Schoepf, U. J.; De Cecco, C. N.; Bogaert, J.; Dobrovie, M.; Symons, R.; Focardi, M.; Gismondi, A.; Lozano-Torres, J.; Rodriguez-Palomares, J. F.; Lanzillo, C.; Di Roma, M.; Moro, C.; Di Giovine, G.; Margonato, D.; De Lazzari, M.; Perazzolo Marra, M.; Nese, A.; Casavecchia, G.; Gravina, M.; Marzo, F.; Carigi, S.; Pica, S.; Lombardi, M.; Censi, S.; Squeri, A.; Palumbo, A.; Gaibazzi, N.; Camastra, G.; Sbarbati, S.; Pedrotti, P.; Masi, A.; Carrabba, N.; Pradella, S.; Timpani, M.; Cicala, G.; Presicci, C.; Puglisi, S.; Sverzellati, N.; Santobuono, V. E.; Pepi, M.; Schwitter, J.; Pontone, G.

doi:10.1093/europace/euaa401

AIMS: The aim of this registry was to evaluate the additional prognostic value of a composite cardiac magnetic resonance (CMR)-based risk score over standard-of-care (SOC) evaluation in a large cohort of consecutive unselected non-ischaemic cardiomyopathy (NICM) patients. METHODS AND RESULTS: In the DERIVATE registry (www.clinicaltrials.gov/registration: RCT#NCT03352648), 1000 (derivation cohort) and 508 (validation cohort) NICM patients with chronic heart failure (HF) and left ventricular ejection fraction <50% were included. All-cause mortality and major adverse arrhythmic cardiac events (MAACE) were the primary and secondary endpoints, respectively. During a median follow-up of 959 days, all-cause mortality and MAACE occurred in 72 (7%) and 93 (9%) patients, respectively. Age and >3 segments with midwall fibrosis on late gadolinium enhancement (LGE) were the only independent predictors of all-cause mortality (HR: 1.036, 95% CI: 1.0117-1.056, P < 0.001 and HR: 2.077, 95% CI: 1.211-3.562, P = 0.008, respectively). For MAACE, the independent predictors were male gender, left ventricular end-diastolic volume index by CMR (CMR-LVEDVi), and >3 segments with midwall fibrosis on LGE (HR: 2.131, 95% CI: 1.231-3.690, P = 0.007; HR: 3.161, 95% CI: 1.750-5.709, P < 0.001; and HR: 1.693, 95% CI: 1.084-2.644, P = 0.021, respectively). A composite clinical and CMR-based risk score provided a net reclassification improvement of 63.7% (P < 0.001) for MAACE occurrence when added to the model based on SOC evaluation. These findings were confirmed in the validation cohort. CONCLUSION: In a large multicentre, multivendor cohort registry reflecting daily clinical practice in NICM work-up, a composite clinical and CMR-based risk score provides incremental prognostic value beyond SOC evaluation, which may have impact on the indication of implantable cardioverter-defibrillator implantation.

CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: an international Registry / Guaricci, A. I.; Masci, P. G.; Muscogiuri, G.; Guglielmo, M.; Baggiano, A.; Fusini, L.; Lorenzoni, V.; Martini, C.; Andreini, D.; Pavon, A. G.; Aquaro, G. D.; Barison, A.; Todiere, G.; Rabbat, M. G.; Tat, E.; Raineri, C.; Valentini, A.; Varga-Szemes, A.; Schoepf, U. J.; De Cecco, C. N.; Bogaert, J.; Dobrovie, M.; Symons, R.; Focardi, M.; Gismondi, A.; Lozano-Torres, J.; Rodriguez-Palomares, J. F.; Lanzillo, C.; Di Roma, M.; Moro, C.; Di Giovine, G.; Margonato, D.; De Lazzari, M.; Perazzolo Marra, M.; Nese, A.; Casavecchia, G.; Gravina, M.; Marzo, F.; Carigi, S.; Pica, S.; Lombardi, M.; Censi, S.; Squeri, A.; Palumbo, A.; Gaibazzi, N.; Camastra, G.; Sbarbati, S.; Pedrotti, P.; Masi, A.; Carrabba, N.; Pradella, S.; Timpani, M.; Cicala, G.; Presicci, C.; Puglisi, S.; Sverzellati, N.; Santobuono, V. E.; Pepi, M.; Schwitter, J.; Pontone, G.. - In: EUROPACE. - ISSN 1532-2092. - 23:7(2021), pp. 1072-1083. [10.1093/europace/euaa401]