scholarly journals Risk Stratification in Idiopathic Dilated Cardiomyopathy Patients Using Cardiovascular Coupling Analysis

2019 ◽  
Vol 10 ◽  
Author(s):  
Javier Rodriguez ◽  
Steffen Schulz ◽  
Beatriz F. Giraldo ◽  
Andreas Voss
Keyword(s):  
Risk Stratification ◽  
Dilated Cardiomyopathy ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Coupling Analysis ◽  
Cardiovascular Coupling

scholarly journals Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy

Heart ◽  
2018 ◽  
Vol 105 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Pamela Frances Brown ◽  
Chris Miller ◽  
Andrea Di Marco ◽  
Matthias Schmitt
Keyword(s):  
Risk Stratification ◽  
Dilated Cardiomyopathy ◽  
Cardiac Mri ◽  
Randomised Trial ◽  
Extracellular Volume ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Diffuse Fibrosis ◽  
Resource Utilisation ◽  
Selection Strategy ◽  
Gadolinium Contrast

Sudden cardiac death (SCD) secondary to arrhythmia remains a risk in those with dilated cardiomyopathy (DCM), an implantable cardiac defibrillator (ICD) is an effective strategy to prevent SCD. Current guidelines recommend selection for ICD based on ejection fraction (EF) less than 35%, however, most SCD occurs in those with EF>35%. Although meta-analysis has demonstrated a survival benefit for primary prevention ICD in DCM, no randomised trial has shown a significant reduction in overall mortality including the most recent ‘Danish Study to Assess the Efficacy of ICDs in Patients With Non-Ischemic Systolic Heat Failure on Mortality’ study. Clearly, a more sophisticated selection strategy is required. Cardiac MRI (CMR) is an ideal non-invasive imaging technique which allows calculation of EF as well as tissue characterisation with gadolinium contrast, parametric mapping and feature tracking. Late gadolinium enhancement detects mid-wall fibrosis in approximately 30% of those with DCM, three meta-analyses have demonstrated an association between fibrosis in DCM and SCD, and those without fibrosis are at low risk of SCD. T1 mapping and extracellular volume (ECV) calculation are methods of demonstrating diffuse fibrosis in the myocardium. Raised ECV and native T1 have been associated with worse outcomes but the relationship to SCD has not been well studied. Undoubtedly, more research is required but CMR has several tools which offer incremental value above EF to improve risk stratification and consequent outcomes and resource utilisation in those with DCM.

Abstract 15759: Arrhythmic Risk Stratification in Patients With Idiopathic Dilated Cardiomyopathy and No Conventional Indications for Implantable Cardiac Defibrillator

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Marco Merlo ◽  
Fabrizio Pirozzi ◽  
Davide Stolfo ◽  
D’Angelo Gianluca ◽  
Marco Alonge ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Dilated Cardiomyopathy ◽  
Previous History ◽  
Left Ventricular ◽  
Muscle Disease ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
History Of ◽  
Duration Of Disease

Background: Primary prevention of major ventricular arrhythmias (MVA) in patients with idiopathic dilated cardiomyopathy (IDCM) is primarily based on left ventricular ejection fraction (LVEF) assessment. Nonetheless, unexpected MVA still affect patients considered at low-risk (LR), attesting the limitation of the current risk stratification. We sought to identify the clinical predictors of MVA in patients with IDCM and no conventional indications for implantable cardioverter defibrillator (ICD). Methods: In this retrospective, case-control study, among 922 patients enrolled in the Heart Muscle Disease Registry of Trieste from 1988 to 2013, we analyzed 414 IDCM patients considered at LR according to the following criteria: LVEF≥36% and no previous episodes of MVA (sustained ventricular tachycardia/non-fatal ventricular fibrillation (SVT/VF), appropriate ICD intervention and sudden cardiac death (SD)). Data were recorded at the last available medical examination before the index event. Patients were optimally treated at the time of index evaluation (87% and 84% of ACE-inhibitors/sartans and beta-blockers, respectively). Results: Over a median follow-up of 43 (IQR 16-116) months, 45 patients (11 % of patients at LR; 31% of the all MVA in whole IDCM population) experienced MVA. The mean age at the time of event was 51±14 years. They were characterized by a previous history of syncope in 10 patients (22%), LVEF of 42±6% with a normal value (>50%) in 10 patients (22%), significant LV dilation (VTDi>90ml/m 2 ) in 16 patients (35%) and left bundle branch block 12 patients (27%). Independent risk factors for MVA in LR subgroup were previous history of syncope (OR 3.41, 1.45-8.03, p=0.004), larger left ventricular dilation (OR 2.62, 1.72-3.99, p<0.0001) and longer duration of disease (OR 1.39, 1.42-2.63, p<0.0001). Conclusions: in a large cohort of IDCM patients nearly one-third of the MVA occurred in a population apparently at LR of events. History of syncope, larger LV dilatation and significant duration of disease emerged as strong predictors of MVA and should be considered in the arrhythmic risk stratification of patients without conventional criteria for SD primary protection.

scholarly journals Noninvasive Arrhythmia Risk Stratification in Idiopathic Dilated Cardiomyopathy

Circulation ◽  
2003 ◽  
Vol 108 (23) ◽  
pp. 2883-2891 ◽  
Author(s):  
Wolfram Grimm ◽  
Michael Christ ◽  
Jennifer Bach ◽  
Hans-Helge Müller ◽  
Bernhard Maisch
Keyword(s):  
Risk Stratification ◽  
Dilated Cardiomyopathy ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Arrhythmia Risk Stratification
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