Abstract
Background
We aimed to develop a risk score (LGE Based Prediction of SCD Risk in Nonischemic Dilated Cardiomyopathy [ESTIMATED]) based on late gadolinium enhancement (LGE) cardiac magnetic
resonance to predict sudden cardiac death (SCD) in patients with nonischemic dilated
cardiomyopathy (NIDCM) and left ventricular ejection fraction ≤ 35%.
Methods
We recruited 395 consecutive middle-aged patients with NIDCM and performed 3-year
follow-up for SCD events. The score was developed and verified in 295 primary prevention
patients, and the predictive value was confirmed by comparing the SCD events between
the high-risk patients stratified by the score and 100 secondary prevention patients.
Results
The ESTIMATED score (constructed by the LGE extent > 14%, syncope, atrial flutter/fibrillation,
nonsustained ventricular tachycardia, advanced atrioventricular block, and age ≤ 20
or > 50 years) showed good calibrations for SCD prediction in the derivation (C-statistic:
0.80, 95% confidence interval: 0.74-0.86) and validation set (C-statistic: 0.80, 95%
confidence interval: 0.71-0.87). By the score, 20.3% of primary prevention patients
were categorized as high risk (≥ 3 points), 28.1% as intermediate risk (2 points),
and 51.6% as low risk (0-1 points) for 3-year SCD events (45.9% vs 20.1% vs 5.1%,
P < 0.0001). The 3-year SCD events were also well in agreement with the score stratification
in patients without implantable cardioverter-defibrillator. High-risk primary prevention
patients selected by the score in the derivation and validation sets had 3-year SCD
events comparable with that in secondary prevention patients (47.6% vs 40.6% vs 38.7%,
P = 0.81).
Conclusions
Our study derived and validated an LGE-based (ESTIMATED) risk score providing refined
SCD prediction. The score may help to identify candidates for primary prevention implantable
cardioverter-defibrillator in patients with NIDCM.
Résumé
Introduction
Nous avions pour objectif d’élaborer un score de risque (ESTIMÉ) fondé sur le rehaussement
tardif après injection de gadolinium (RTG) en imagerie cardiaque par résonance magnétique
pour prédire la mort subite d’origine cardiaque (MSOC) des patients ayant une cardiomyopathie
dilatée non ischémique (CMDNI) et une fraction d’éjection ventriculaire ≤ 35 %.
Méthodes
Nous avons recruté 395 patients consécutifs d’âge moyen qui avaient une CMDNI et réalisé
un suivi de 3 ans sur les événements de MSOC. Nous avons élaboré le score et l’avons
vérifié auprès de 295 patients en prévention primaire, et nous avons confirmé la valeur
prédictive en comparant les événements de MSOC entre les patients exposés à un risque
élevé stratifiés selon le score et 100 patients en prévention secondaire.
Résultats
Le score ESTIMÉ (élaboré par l’étendue de RTG > 14 %, la syncope, le flutter ou la
fibrillation auriculaire, la tachycardie ventriculaire non soutenue, le bloc auriculo-ventriculaire
avancé et l’âge ≤ 20 ou > 50 ans) a montré de bons étalonnages pour prédire la MSOC
dans la dérivation (statistique C : 0,80, intervalle de confiance [IC] à 95 % : 0,74-0,86)
et l’ensemble de validation (statistique C : 0,80, IC à 95 % : 0,71-0,87). Selon le
score, 20,3 % des patients en prévention primaire ont été classés dans la catégorie
des patients exposés à un risque élevé (≥ 3 points), 28,1 %, dans la catégorie des
patients exposés à un risque intermédiaire (2 points), et 51,6 %, dans la catégorie
des patients exposés à un risque faible (0-1 point) de subir des événements de MSOC
durant 3 ans (45,9 % vs 20,1 % vs 5,1 %, P < 0,0001). Les événements de MSOC durant 3 ans se sont révélés conformes à la stratification
par score des patients sans défibrillateur cardioverteur implantable. Les patients
en prévention primaire exposés à un risque élevé sélectionnés par le score dans la
dérivation et les ensembles de validation ont eu des événements de MSOC durant les
3 ans comparables à ceux des patients en prévention secondaire (47,6 % vs 40,6 % vs 38,7 %, P = 0,81).
Conclusions
Notre étude a permis d’établir et de valider un score de risque (ESTIMÉ) fondé sur
le RTG qui fournit une prédiction affinée de la MSOC. Le score peut aider à déterminer
les candidats à l’implantation d’un défibrillateur cardioverteur en prévention primaire
parmi les patients ayant une CMDNI.
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Article info
Publication history
Published online: November 15, 2019
Accepted:
November 5,
2019
Received:
July 28,
2019
Footnotes
See editorial by Dorian et al., pages 1006–1008 of this issue.
See page 1129 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Predicting Sudden Death in Dilated Cardiomyopathy: The Potential Power of Magnetic Resonance Imaging as a Critical ToolCanadian Journal of CardiologyVol. 36Issue 7
- PreviewHeart failure caused by left-ventricular dysfunction is a growing problem in contemporary cardiology practice, and the incidence of nonischemic dilated cardiomyopathy (NIDCM) is increasing. Medical therapy for NIDCM has evolved and improved substantially in recent years, with improved prognosis;1 however, sudden unexpected death, presumably often caused by ventricular tachycardia or fibrillation, remains an important and incompletely understood problem in patients with NIDCM. Implantable cardioverter defibrillators (ICDs) are effective in terminating sustained ventricular tachycardia or ventricular fibrillation if they occur, and thus it seems self-evident that defibrillators would reduce mortality in patients at more than minimal risk of sustained ventricular arrhythmias with NIDCM.
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