Late gadolinium enhancement and outcome of cardiac resynchronization therapy in non-ischemic cardiomyopathy
Por:
Anguera, I, Faga, V, Jimenez-Candil, J, Moreno-Weidmann, Z, Santos-Ortega, A, Jimenez-Jaimez, J, Rodriguez-García, J, Claver, E, Meré, J, Jovells-Vaque, S, Diez-Lopez, C, Hernández, J, Rivas-Gandara, N, Macías, R, García-Cosculluela, D, Comin-Colet, J, Di Marco, A
Publicada:
1 ene 2025
Ahead of Print:
1 oct 2024
Resumen:
Background: It is uncertain whether CRT with defibrillator (CRTD) is superior to CRT with pacemaker (CRTP) in NICM. Patients with low arrhythmic risk and high probability of response to CRT might be ideal candidates for CRTP. We aimed to evaluate predictors of ventricular arrhythmias and of echocardiographic response to cardiac resynchronization therapy (CRT) in non-ischemic cardiomyopathy (NICM). Methods: Multicenter, retrospective observational study of NICM patients with left ventricular ejection fraction (LVEF) <= 35 %, cardiac magnetic resonance with analysis of late gadolinium enhancement (LGE) available and de-novo CRT implant. Echocardiographic response to CRT was defined as an improvement in LVEF >= 10 %. The combined arrhythmic endpoint included sustained ventricular tachycardia, appropriate ICD therapy, resuscitated cardiac arrest and sudden death. Results: We included 167 patients, with a median follow-up of 63 months. LGE was present in 77 (46 %). Response to CRT occurred in 68 % of patients, more frequently in LGE- than in LGE+ (81 % vs 53 %, p < 0.001). Absence of LGE (OR 3.4, p = 0.002), was an independent predictor of response to CRT. The arrhythmic endpoint occurred in 19 patients (11 %). Among LGE- patients there were zero arrhythmic events as compared to a 25 % cumulative incidence in LGE+ (p < 0.001). Presence of LGE (HR 22.5, p < 0.001), was an independent predictor of the arrhythmic endpoint. Conclusion: Absence of LGE identifies patients at minimal arrhythmic risk and with high probability of response to CRT. Thus, they might be ideal candidates to CRT-P.
Filiaciones:
Anguera, I:
Bellvitge Univ Hosp, Cardiol Dept, Barcelona 08907, Spain
Inst Invest Biomed Bellvitge IDIBELL, Cardiovasc Resp & Syst Dis & Cellular Program, Bioheart Grp, Lhospitalet De Llobregat, Spain
Faga, V:
Bellvitge Univ Hosp, Cardiol Dept, Barcelona 08907, Spain
Inst Invest Biomed Bellvitge IDIBELL, Cardiovasc Resp & Syst Dis & Cellular Program, Bioheart Grp, Lhospitalet De Llobregat, Spain
Jimenez-Candil, J:
IBSAL Hosp Univ, Cardiol Dept, CIBER CV, Salamanca, Spain
Univ Salamanca, Salamanca, Spain
Moreno-Weidmann, Z:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Santos-Ortega, A:
Hosp Valle De Hebron, Barcelona, Spain
Jimenez-Jaimez, J:
Hosp Virgen Nieves, Granada, Spain
Rodriguez-García, J:
Bellvitge Univ Hosp, Cardiol Dept, Barcelona 08907, Spain
Inst Invest Biomed Bellvitge IDIBELL, Cardiovasc Resp & Syst Dis & Cellular Program, Bioheart Grp, Lhospitalet De Llobregat, Spain
Claver, E:
Bellvitge Univ Hosp, Cardiol Dept, Barcelona 08907, Spain
Inst Invest Biomed Bellvitge IDIBELL, Cardiovasc Resp & Syst Dis & Cellular Program, Bioheart Grp, Lhospitalet De Llobregat, Spain
Meré, J:
Bellvitge Univ Hosp, Cardiol Dept, Barcelona 08907, Spain
Inst Invest Biomed Bellvitge IDIBELL, Cardiovasc Resp & Syst Dis & Cellular Program, Bioheart Grp, Lhospitalet De Llobregat, Spain
Jovells-Vaque, S:
Inst Invest Biomed Bellvitge IDIBELL, Cardiovasc Resp & Syst Dis & Cellular Program, Bioheart Grp, Lhospitalet De Llobregat, Spain
Diez-Lopez, C:
Bellvitge Univ Hosp, Cardiol Dept, Barcelona 08907, Spain
Inst Invest Biomed Bellvitge IDIBELL, Cardiovasc Resp & Syst Dis & Cellular Program, Bioheart Grp, Lhospitalet De Llobregat, Spain
Hernández, J:
IBSAL Hosp Univ, Cardiol Dept, CIBER CV, Salamanca, Spain
Rivas-Gandara, N:
Hosp Valle De Hebron, Barcelona, Spain
Macías, R:
Hosp Virgen Nieves, Granada, Spain
García-Cosculluela, D:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Comin-Colet, J:
Bellvitge Univ Hosp, Cardiol Dept, Barcelona 08907, Spain
Inst Invest Biomed Bellvitge IDIBELL, Cardiovasc Resp & Syst Dis & Cellular Program, Bioheart Grp, Lhospitalet De Llobregat, Spain
Inst Catala Salut, Innovat Res & Univ Dept, Tortosa, Spain
Univ Barcelona, Sch Med, Dept Clin Sci, Barcelona, Spain
CIBER CV, Ctr Invest Biomed Red Enfermedades Cardiovasc, Madrid, Spain
Di Marco, A:
Bellvitge Univ Hosp, Cardiol Dept, Barcelona 08907, Spain
Inst Invest Biomed Bellvitge IDIBELL, Cardiovasc Resp & Syst Dis & Cellular Program, Bioheart Grp, Lhospitalet De Llobregat, Spain
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