Kyohei Marume1, Teruo Noguchi2, Emi Tateishi1, Yoshiaki Morita1, Tsukasa Kamakura1, Kohei Ishibashi1, Takashi Noda1, Hiroyuki Miura1, Kunihiro Nishimura1, Michikazu Nakai1, Naoaki Yamada1, Kenichi Tsujita1, Toshihisa Anzai1, Kengo Kusano1, Hisao Ogawa1, Satoshi Yasuda1. 1. Departments of Cardiovascular Medicine (K.M., K.I., T.N., H.M., K.K., H.O., S.Y.), Radiology (E.T., Y.M.), and Statistics and Data Analysis (K.N., M.N.), National Cerebral and Cardiovascular Center, Suita, Japan. Department of Radiology, Osaka Neurological Institute, Toyonaka, Japan (N.Y.). Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.A.). Departments of Cardiovascular Medicine (K.M., K.T.) and Advanced Cardiovascular Medicine (T.A., K.K., S.Y.), Graduate School of Medical Sciences, Kumamoto University, Japan. 2. Departments of Cardiovascular Medicine (K.M., K.I., T.N., H.M., K.K., H.O., S.Y.), Radiology (E.T., Y.M.), and Statistics and Data Analysis (K.N., M.N.), National Cerebral and Cardiovascular Center, Suita, Japan. Department of Radiology, Osaka Neurological Institute, Toyonaka, Japan (N.Y.). Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.A.). Departments of Cardiovascular Medicine (K.M., K.T.) and Advanced Cardiovascular Medicine (T.A., K.K., S.Y.), Graduate School of Medical Sciences, Kumamoto University, Japan. tnoguchi@ncvc.go.jp.
Abstract
BACKGROUND: The aim of this study was to investigate whether the combination of QRS duration ≥120 ms (wide QRS duration [wQRS]) and late gadolinium enhancement (LGE) is a precise prognostic indicator for dilated cardiomyopathy. METHODS AND RESULTS: We investigated the association between the combination of LGE plus wQRS and the primary end point (all-cause death) and a composite of sudden cardiac death (SCD) or aborted SCD in 531 patients with dilated cardiomyopathy. We also analyzed the association between the combination of LGE and wQRS and these end points among patients with a class I indication for implantable cardioverter defibrillator implantation. We divided study patients into 3 groups according to LGE status and QRS duration: 2 negative indices (LGE negative and narrow QRS), 1 positive index (LGE positive or wQRS), or 2 positive indices (LGE positive and wQRS), and followed them for 3.8 years. Multivariable Cox regression analysis identified 2 positive indices as a significant predictor of all-cause death (hazard ratio, 4.29 [1.19-15.47]; P=0.026). Among 317 patients with a class I indication for implantable cardioverter defibrillator, the 5-year event rate of SCD or aborted SCD was the lowest in the 2 negative indices group (1.4%). With propensity score-matching cohorts, the 2 negative indices group had a significantly lower event rate of SCD or aborted SCD than the other 2 groups (hazard ratio, 0.12 [0.01-0.97]; P=0.046). CONCLUSIONS: The combination of LGE and wQRS provides additional prognostic stratification compared with LGE status alone and might improve the appropriate use of implantable cardioverter defibrillator therapy in patients with dilated cardiomyopathy.
BACKGROUND: The aim of this study was to investigate whether the combination of QRS duration ≥120 ms (wide QRS duration [wQRS]) and late gadolinium enhancement (LGE) is a precise prognostic indicator for dilated cardiomyopathy. METHODS AND RESULTS: We investigated the association between the combination of LGE plus wQRS and the primary end point (all-cause death) and a composite of sudden cardiac death (SCD) or aborted SCD in 531 patients with dilated cardiomyopathy. We also analyzed the association between the combination of LGE and wQRS and these end points among patients with a class I indication for implantable cardioverter defibrillator implantation. We divided study patients into 3 groups according to LGE status and QRS duration: 2 negative indices (LGE negative and narrow QRS), 1 positive index (LGE positive or wQRS), or 2 positive indices (LGE positive and wQRS), and followed them for 3.8 years. Multivariable Cox regression analysis identified 2 positive indices as a significant predictor of all-cause death (hazard ratio, 4.29 [1.19-15.47]; P=0.026). Among 317 patients with a class I indication for implantable cardioverter defibrillator, the 5-year event rate of SCD or aborted SCD was the lowest in the 2 negative indices group (1.4%). With propensity score-matching cohorts, the 2 negative indices group had a significantly lower event rate of SCD or aborted SCD than the other 2 groups (hazard ratio, 0.12 [0.01-0.97]; P=0.046). CONCLUSIONS: The combination of LGE and wQRS provides additional prognostic stratification compared with LGE status alone and might improve the appropriate use of implantable cardioverter defibrillator therapy in patients with dilated cardiomyopathy.
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Authors: Marthe A J Becker; Cornelis P Allaart; Alwin Zweerink; Jan H Cornel; Peter M van de Ven; Albert C van Rossum; Tjeerd Germans Journal: Int J Cardiol Heart Vasc Date: 2020-01-25
Authors: Gabriel Balaban; Brian P Halliday; Bradley Porter; Wenjia Bai; Ståle Nygåard; Ruth Owen; Suzan Hatipoglu; Nuno Dias Ferreira; Cemil Izgi; Upasana Tayal; Ben Corden; James Ware; Dudley J Pennell; Daniel Rueckert; Gernot Plank; Christopher A Rinaldi; Sanjay K Prasad; Martin J Bishop Journal: JACC Clin Electrophysiol Date: 2020-10-29