Combination of late gadolinium enhancement and genotype improves prediction of prognosis in non-ischaemic dilated cardiomyopathy
Author
Mirelis, Jesús G.; Escobar Lopez, Luis; Ochoa, Juan Pablo; Espinosa Bayal, María Ángeles

Entity
UAM. Departamento de MedicinaPublisher
WileyDate
2022-05-22Citation
10.1002/ejhf.2514
European Journal of Heart Failure 24.7 (2022): 1183–1196
ISSN
1879-0844 (online)DOI
10.1002/ejhf.2514Funded by
This work was supported by grants from the Instituto de Salud Carlos III (ISCIII) (PI18/0004, PI19/01283, PI20/0320). (Co-funded by European Regional Development Fund/European Social Fund ‘A way to make Europe’/‘Investing in your future’). The Hospital Universitario Puerta de Hierro Majadahonda, the Hospital Clinic, the Hospital Vall d’Hebron, the Hospital General Universitario Gregorio Marañón and the Hospital Universitario Virgen de la Arrixaca are members of the European Reference Network for rare, low-prevalence, and complex diseases of the heart (ERN GUARD-Heart). The CNIC is supported by the ISCIII, MCIN, the Pro-CNIC Foundation, and the Severo Ochoa Centers of Excellence program (CEX2020-001041-S). Conflict of interest: none declaredProject
Gobierno de España. PI18/0004; Gobierno de España. PI19/01283; Gobierno de España. PI20/00320Editor's Version
https://doi.org/10.1002/ejhf.2514Subjects
Cardiac magnetic resonance; Dilated cardiomyopathy; End-stage heart failure; Genotype; Late gadolinium enhancement; Sudden cardiac death; MedicinaRights
© 2022 The Authors
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
Abstract
Aims: Genotype and left ventricular scar on cardiac magnetic resonance (CMR) are increasingly recognized as risk markers for adverse outcomes in non-ischaemic dilated cardiomyopathy (DCM). We investigated the combined influence of genotype and late gadolinium enhancement (LGE) in assessing prognosis in a large cohort of patients with DCM. Methods and results: Outcomes of 600 patients with DCM (53.3 ± 14.1 years, 66% male) who underwent clinical CMR and genetic testing were retrospectively analysed. The primary endpoints were end-stage heart failure (ESHF) and malignant ventricular arrhythmias (MVA). During a median follow-up of 2.7 years (interquartile range 1.3–4.9), 24 (4.00%) and 48 (8.00%) patients had ESHF and MVA, respectively. In total, 242 (40.3%) patients had pathogenic/likely pathogenic variants (positive genotype) and 151 (25.2%) had LGE. In survival analysis, positive LGE was associated with MVA and ESHF (both, p < 0.001) while positive genotype was associated with ESHF (p = 0.034) but not with MVA (p = 0.102). Classification of patients according to genotype (G+/G−) and LGE presence (L+/L−) revealed progressively increasing events across L−/G−, L−/G+, L+/G− and L+/G+ groups and resulted in optimized MVA and ESHF prediction (p < 0.001 and p = 0.001, respectively). Hazard ratios for MVA and ESHF in patients with either L+ or G+ compared with those with L−/G− were 4.71 (95% confidence interval: 2.11–10.50, p < 0.001) and 7.92 (95% confidence interval: 1.86–33.78, p < 0.001), respectively. Conclusion: Classification of patients with DCM according to genotype and LGE improves MVA and ESHF prediction. Scar assessment with CMR and genotyping should be considered to select patients for primary prevention implantable cardioverter-defibrillator placement
Files in this item
Google Scholar:Mirelis, Jesús G.
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Escobar Lopez, Luis
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Ochoa, Juan Pablo
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Espinosa Bayal, María Ángeles
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Villacorta, Eduardo
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Navarro, Marina
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Casas, Guillem
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Mora Ayestarán, Nerea
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Barriales Villa, Roberto
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Mogollón Jiménez, María Victoria
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García Pinilla, José M.
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García Granja, Pablo E.
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Climent, Vicente
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Palomino Doza, Julian
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García Álvarez, Ana
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Álvarez Barredo, María
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Cabrera Borrego, Eva
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Ripoll Vera, Tomás
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Peña Peña, María Luisa
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Rodríguez González, Elena
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Gallego Delgado, María
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Gonzalez Carrillo, Josefa
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Fernández Ávila, Ana
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Rodríguez Palomares, José F.
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Brugada, Ramón
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Bayes Genis, Antoni
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Dominguez, Fernando
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García Pavía, Pablo
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