Andrea Igoren Guaricci1, Pier Giorgio Masci2, Giuseppe Muscogiuri3, Marco Guglielmo3, Andrea Baggiano3, Laura Fusini3, Valentina Lorenzoni4, Chiara Martini5, Daniele Andreini3, Anna Giulia Pavon6, Giovanni D Aquaro7, Andrea Barison7, Giancarlo Todiere7, Mark G Rabbat8, Emily Tat8, Claudia Raineri9, Adele Valentini10, Akos Varga-Szemes11, U Joseph Schoepf11, Carlo N De Cecco11,12, Jan Bogaert13, Monica Dobrovie13, Rolf Symons13, Marta Focardi14, Annalaura Gismondi14, Jordi Lozano-Torres15, Josè F Rodriguez-Palomares15,16, Chiara Lanzillo17, Mauro Di Roma17, Claudio Moro18, Gabriella Di Giovine19, Davide Margonato19, Manuel De Lazzari20, Martina Perazzolo Marra20, Alberto Nese21, Grazia Casavecchia22, Matteo Gravina23, Francesca Marzo24, Samuela Carigi24, Silvia Pica25, Massimo Lombardi25, Stefano Censi26, Angelo Squeri26, Alessandro Palumbo5, Nicola Gaibazzi27, Giovanni Camastra28, Stefano Sbarbati29, Patrizia Pedrotti30, Ambra Masi30, Nazario Carrabba31, Silvia Pradella32, Mauro Timpani33, Gloria Cicala5, Cristina Presicci5, Sara Puglisi5, Nicola Sverzellati5, Vincenzo Ezio Santobuono1, Mauro Pepi3, Juerg Schwitter6,34, Gianluca Pontone3. 1. University Cardiology Unit, Policlinic University Hospital, Bari, Italy. 2. Cardiovascular Imaging Department, King's College London, London, UK. 3. Department of Cardiovascular, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy. 4. Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy. 5. Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy. 6. Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Switzerland. 7. U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy. 8. Loyola University of Chicago, Chicago, IL, USA. 9. Department of Cardiology, Città della salute e della Scienza - Ospedale Molinette -Turin, Pavia, Italy. 10. Department of Radiology, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy. 11. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. 12. Division of Cardiothoracic Imaging, Emory University, Atlanta, GA, USA. 13. Department of Radiology, University Hospital Leuven, Leuven, Belgium. 14. Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy. 15. Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain. 16. Centro de Investigaciín Biomédica en Red-CV, CIBER CV. Spain. 17. Cardiology Department, Policlinico Casilino, Rome, Italy. 18. Department of Cardiology, ASST Monza, P.O. Desio, Italy. 19. Department of Cardiology, Policlinico di Monza, Monza, Italy. 20. Department of Radiology, University of Foggia, Foggia, Italy. 21. Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy. 22. Cardiology Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy. 23. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. 24. Department of Cardiology, Infermi Hospital, Rimini, Italy. 25. Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. 26. Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy. 27. Department of Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy. 28. Cardiac Department, Vannini Hospital Rome, Rome, Italy. 29. Radiology Department, Vannini Hospital Rome, Rome, Italy. 30. 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 31. Cardiovascular and Thoracic Department of Careggi Hospital, Florence, Italy. 32. Department of Radiology, Careggi Hospital, Florence, Italy. 33. Department of Neuroscience, Imaging and Clinical Sciences, SS Annunziata Hospital, Chieti, Italy. 34. Lausanne University, Faculty of Biology and Medicine, Lausanne, Switzerland.
Abstract
AIMS: The aim of this registry was to evaluate the additional prognostic value of a composite cardiac magnetic resonance (CMR)-based risk score over standard-of-care (SOC) evaluation in a large cohort of consecutive unselected non-ischaemic cardiomyopathy (NICM) patients. METHODS AND RESULTS: In the DERIVATE registry (www.clinicaltrials.gov/registration: RCT#NCT03352648), 1000 (derivation cohort) and 508 (validation cohort) NICM patients with chronic heart failure (HF) and left ventricular ejection fraction <50% were included. All-cause mortality and major adverse arrhythmic cardiac events (MAACE) were the primary and secondary endpoints, respectively. During a median follow-up of 959 days, all-cause mortality and MAACE occurred in 72 (7%) and 93 (9%) patients, respectively. Age and >3 segments with midwall fibrosis on late gadolinium enhancement (LGE) were the only independent predictors of all-cause mortality (HR: 1.036, 95% CI: 1.0117-1.056, P < 0.001 and HR: 2.077, 95% CI: 1.211-3.562, P = 0.008, respectively). For MAACE, the independent predictors were male gender, left ventricular end-diastolic volume index by CMR (CMR-LVEDVi), and >3 segments with midwall fibrosis on LGE (HR: 2.131, 95% CI: 1.231-3.690, P = 0.007; HR: 3.161, 95% CI: 1.750-5.709, P < 0.001; and HR: 1.693, 95% CI: 1.084-2.644, P = 0.021, respectively). A composite clinical and CMR-based risk score provided a net reclassification improvement of 63.7% (P < 0.001) for MAACE occurrence when added to the model based on SOC evaluation. These findings were confirmed in the validation cohort. CONCLUSION: In a large multicentre, multivendor cohort registry reflecting daily clinical practice in NICM work-up, a composite clinical and CMR-based risk score provides incremental prognostic value beyond SOC evaluation, which may have impact on the indication of implantable cardioverter-defibrillator implantation. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The aim of this registry was to evaluate the additional prognostic value of a composite cardiac magnetic resonance (CMR)-based risk score over standard-of-care (SOC) evaluation in a large cohort of consecutive unselected non-ischaemic cardiomyopathy (NICM) patients. METHODS AND RESULTS: In the DERIVATE registry (www.clinicaltrials.gov/registration: RCT#NCT03352648), 1000 (derivation cohort) and 508 (validation cohort) NICM patients with chronic heart failure (HF) and left ventricular ejection fraction <50% were included. All-cause mortality and major adverse arrhythmic cardiac events (MAACE) were the primary and secondary endpoints, respectively. During a median follow-up of 959 days, all-cause mortality and MAACE occurred in 72 (7%) and 93 (9%) patients, respectively. Age and >3 segments with midwall fibrosis on late gadolinium enhancement (LGE) were the only independent predictors of all-cause mortality (HR: 1.036, 95% CI: 1.0117-1.056, P < 0.001 and HR: 2.077, 95% CI: 1.211-3.562, P = 0.008, respectively). For MAACE, the independent predictors were male gender, left ventricular end-diastolic volume index by CMR (CMR-LVEDVi), and >3 segments with midwall fibrosis on LGE (HR: 2.131, 95% CI: 1.231-3.690, P = 0.007; HR: 3.161, 95% CI: 1.750-5.709, P < 0.001; and HR: 1.693, 95% CI: 1.084-2.644, P = 0.021, respectively). A composite clinical and CMR-based risk score provided a net reclassification improvement of 63.7% (P < 0.001) for MAACE occurrence when added to the model based on SOC evaluation. These findings were confirmed in the validation cohort. CONCLUSION: In a large multicentre, multivendor cohort registry reflecting daily clinical practice in NICM work-up, a composite clinical and CMR-based risk score provides incremental prognostic value beyond SOC evaluation, which may have impact on the indication of implantable cardioverter-defibrillator implantation. Published on behalf of the European Society of Cardiology. All rights reserved.
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Authors: Giuseppe Muscogiuri; Andrea Igoren Guaricci; Nicola Soldato; Riccardo Cau; Luca Saba; Paola Siena; Maria Grazia Tarsitano; Elisa Giannetta; Davide Sala; Paolo Sganzerla; Marco Gatti; Riccardo Faletti; Alberto Senatieri; Gregorio Chierchia; Gianluca Pontone; Paolo Marra; Mark G Rabbat; Sandro Sironi Journal: J Clin Med Date: 2022-09-26 Impact factor: 4.964