Amino-terminal Pro-B-Type Natriuretic Peptide Among Patients Living With Both Human Immunodeficiency Virus and Heart Failure

Abstract Background Among persons living with human immunodeficiency virus (PHIV), incident heart failure (HF) rates are increased and outcomes are worse; however, the role of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations among PHIV with HF has not been characterized. Methods Patients were derived from a registry of those hospitalized with HF at an academic center in a calender year. We compared the NT-proBNP concentrations and the changes in NT-proBNP levels between PHIV with HF and uninfected controls with HF. Results Among 2578 patients with HF, there were 434 PHIV; 90% were prescribed antiretroviral therapy and 62% were virally suppressed. As compared to controls, PHIV had higher admission (3822 [IQR, 2413–7784] pg/ml vs 5546 [IQR, 3257–8792] pg/ml, respectively; P < .001), higher discharge (1922 [IQR, 1045–4652] pg/ml vs 3372 [IQR, 1553–5452] pg/ml, respectively; P < .001), and lower admission-to-discharge changes in NT-proBNP levels (32 vs 48%, respectively; P = .007). Similar findings were noted after stratifying based on left ventricular ejection fraction (LVEF). In a multivariate analysis, cocaine use, a lower LVEF, a higher NYHA class, a higher viral load (VL), and a lower CD4 count were associated with higher NT-proBNP concentrations. In follow-up, among PHIV, a higher admission NT-proBNP concentration was associated with increased cardiovascular mortality (first tertile, 11.5; second tertile, 20; third tertile, 44%; P < .001). Among PHIV, each doubling of NT-proBNP was associated with a 19% increased risk of death. However, among patients living without HIV, each doubling was associated with a 27% increased risk; this difference was attenuated among PHIV with lower VLs and higher CD4 counts. Conclusions PHIV with HF had higher admission and discharge NT-proBNP levels, and less change in NT-proBNP concentrations. Among PHIV, VLs and CD4 counts were associated with NT-proBNP concentrations; in follow-up, higher NT-proBNP levels among PHIV were associated with cardiovascular mortality.

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P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

European Heart Journal ◽

10.1093/eurheartj/ehz748.0570 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O L Rueda Ochoa ◽

L R Bons ◽

S Rohde ◽

K E L Ghoud ◽

R Budde ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Mortality ◽

Total Mortality ◽

Population Based ◽

Cardiovascular Outcomes ◽

Increased Risk ◽

Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

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Nontyphi Salmonella Empyema with Bronchopleural Fistula in a Patient with Human Immunodeficiency Virus

Case Reports in Pulmonology ◽

10.1155/2018/4761725 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Douglas Bretzing ◽

Tasnim Lat ◽

Andrew Shakespeare ◽

Mary Lee ◽

Salim Surani ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Bronchopleural Fistula ◽

Fibrinolytic Therapy ◽

Watery Diarrhea ◽

Increased Risk ◽

Pulmonary Manifestations ◽

Immunodeficiency Virus ◽

Night Sweats ◽

The Right

Patients with human immunodeficiency virus (HIV) have an increased risk of inoculation with nontyphoid Salmonella compared to the general population. While nontyphoid Salmonella commonly manifests as gastroenteritis, Salmonella bacteremia can be seen in patients with HIV. We present a case of disseminated Salmonellosis in a patient with HIV complicated by bronchopleural fistula and secondary empyema. Case Presentation. A 40-year-old African American male with HIV noncompliant with HAART therapy presented with complaints of generalized weakness, weight loss, cough, night sweats, and nonbloody, watery diarrhea of four weeks’ duration. A computed tomography (CT) scan demonstrated a bilobed large, thick-walled cavitary lesion in the right upper lobe communicating with the pleural space to form a bronchopleural fistula. Thoracentesis yielded growth of nontyphi Salmonella species consistent with empyema; he was treated with intravenous Ceftriaxone and underwent placement of chest tube for drainage of empyema with instillation of alteplase/dornase twice daily for three days. Repeat CT chest showed a hydropneumothorax. The patient subsequently underwent video-assisted thoracoscopy with decortication. The patient continued to improve and follow-up CT chest demonstrated improved loculated right pneumothorax with resolution of the right bronchopleural fistula and resolution of the cavitary lesions. Discussion. We describe one of the few cases of development of bronchopulmonary fistula and the formation of empyema in the setting of disseminated Salmonella. Empyema complicated by bronchopulmonary fistula likely led to failure of intrapleural fibrinolytic therapy and the patient ultimately required decortication in addition to antibiotics. While Salmonella bacteremia can be seen in immunocompromised patients, extraintestinal manifestations of Salmonella infection such as empyema and bronchopleural fistulas are uncommon. Bronchopleural fistulas most commonly occur as a postoperative complication of pulmonary resection. Conclusions. This case highlights the unusual pulmonary manifestations that can occur due to disseminated Salmonella in an immunocompromised patient as well as complex management decisions related to these complications.

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Prognostic value of atrial fibrillation in patients with heart failure and different left ventricular ejection fraction: results of the multicenter RIF-CHF register

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4200 ◽

2021 ◽

Vol 26 (1) ◽

pp. 4200

Author(s):

I. V. Zhirov ◽

N. V. Safronova ◽

Yu. F. Osmolovskaya ◽

S. N. Тereschenko

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Cardiovascular Mortality ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Number Of Patients ◽

Increased Risk

Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with HF and AF is increasing every year.Aim. To analyze the effect of clinical course and management of HF and AF on the outcomes.Material and methods. The data of 1,003 patients from the first Russian register of patients with HF and AF (RIF-CHF) were analyzed. The endpoints included hospitalization due to decompensated HF, cardiovascular mortality, thromboembolic events, and major bleeding. Predictors of unfavorable outcomes were analyzed separately for patients with HF with preserved ejection fraction (AF+HFpEF), mid-range ejection fraction (AF+HFmrEF), and reduced ejection fraction (AF+HFrEF).Results. Among all patients with HF, 39% had HFpEF, 15% — HFmrEF, and 46% — HFrEF. A total of 57,2% of patients were rehospitalized due to decompensated HF within one year. Hospitalization risk was the highest for HFmrEF patients (66%, p=0,017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15,5% vs 5,4% in other groups, p<0,001) but not ischemic stroke (2,4% vs 3%, p=0,776). Patients with HFpEF had lower risk to achieve the composite endpoint (stroke+MI+cardiovascular death) as compared to patients with HFmrEF and HFrEF (12,7% vs 22% and 25,5%, p<0,001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and selected therapy had different effects on the risk of unfavorable outcomes depending on ejection fraction group.Conclusion. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with unfavorable outcomes. The demographic and clinical characteristics of patients with mid-range ejection fraction demonstrate that these patients need to be studied as a separate cohort.

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Socioeconomic deprivation and mode-specific outcomes in patients with chronic heart failure

Heart ◽

10.1136/heartjnl-2017-312539 ◽

2018 ◽

Vol 104 (12) ◽

pp. 993-998 ◽

Cited By ~ 18

Author(s):

Klaus K Witte ◽

Peysh A Patel ◽

Andrew M N Walker ◽

Clyde B Schechter ◽

Michael Drozd ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cardiovascular Mortality ◽

Left Ventricular ◽

Socioeconomic Deprivation ◽

Left Ventricular Ejection ◽

Geographical Regions ◽

Unit Increase ◽

Cumulative Duration

ObjectiveTo characterise the association between socioeconomic deprivation and adverse outcomes in patients with chronic heart failure (CHF).MethodsWe prospectively observed 1802 patients with CHF and left ventricular ejection fraction (LVEF) ≤45%, recruited in four UK hospitals between 2006 and 2014. We assessed the association between deprivation defined by the UK Index of Multiple Deprivation (IMD) and: mode-specific mortality (mean follow-up 4 years); mode-specific hospitalisation; and the cumulative duration of hospitalisation (after 1 year).ResultsA 45-point difference in mean IMD score was noted between patients residing in the least and most deprived quintiles of geographical regions. Deprivation was associated with age, sex and comorbidity, but not CHF symptoms, LVEF or prescribed drug therapy. IMD score was associated with the risk of age-sex adjusted all-cause mortality (6% higher risk per 10-unit increase in IMD score; 95% CI 2% to 10%; P=0.004), and non-cardiovascular mortality (9% higher risk per 10-unit increase in IMD score; 95% CI 3% to 16%; P=0.003), but not cardiovascular mortality. All-cause, but not heart failure-specific, hospitalisation was also more common in the most deprived patients. Overall, patients spent a cumulative 3.3 days in hospital during 1 year of follow-up, with IMD score being associated with the age-sex adjusted cumulative duration of hospitalisations (4% increase in duration per 10-unit increase in IMD score; 95% CI 3% to 6%; P<0.0005).ConclusionsSocioeconomic deprivation in people with CHF is linked to increased risk of death and hospitalisation due to an excess of non-cardiovascular events.

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Vital exhaustion and cardiovascular prognosis in myocardial infarction and heart failure: predictive power of different trajectories

Psychological Medicine ◽

10.1017/s0033291710001133 ◽

2010 ◽

Vol 41 (4) ◽

pp. 731-738 ◽

Cited By ~ 20

Author(s):

O. R. F. Smith ◽

N. Kupper ◽

J. Denollet ◽

P. de Jonge

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Hospital Readmission ◽

Cardiovascular Events ◽

Cardiac Patients ◽

Left Ventricular Ejection ◽

Vital Exhaustion ◽

Cardiovascular Prognosis ◽

Increased Risk

BackgroundWe examined the different trajectories of vital exhaustion (VE) over a 12-month period and their impact on prognosis in a sample of myocardial infarction (MI) and chronic heart failure (CHF) patients.MethodConsecutive MI (n=407) and CHF patients (n=297) were assessed at baseline, and at 3- and 12-month follow-up for symptoms of VE. Latent growth mixture modelling was used to examine the course of VE over time. The combined clinical endpoint was defined as cardiac hospital readmission or death.ResultsFour distinct trajectories for VE were found: low VE, decreasing VE, increasing VE, and severe VE. Sex, marital status, left ventricular ejection fraction, psychotropic medication, sample group (CHF v. MI) and depressive symptoms were associated with VE, varying according to classes. The mean follow-up period was 25.3 months in which 34.7% of the patients experienced an event. Multivariate Cox regression showed that, compared with patients in the low VE class, patients in the increasing VE class [hazard ratio (HR)=1.16, 95% confidence interval (CI) 1.58–3.61, p=0.01], and the severe VE class (HR=1.69, 95% CI 1.31–2.64, p=0.02) had an increased risk for adverse cardiovascular events (i.e. cardiovascular hospital readmission or cardiovascular death). Decreasing VE was not related to adverse cardiovascular events (HR=0.97, 95% CI 0.66–1.69, p=0.81).ConclusionsVE trajectories varied across cardiac patients, and had a differential effect on cardiovascular outcome. Increasing VE and severe VE classes were predictors of poor cardiovascular prognosis. These results suggest that identification of cardiac patients with an increased risk of adverse health outcomes should be based on multiple assessments of VE.

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Brain Large Artery Lymphocytic Inflammation and Human Immunodeficiency Virus-Related Brain Arterial Remodeling

Journal of Virology ◽

10.1128/jvi.00081-18 ◽

2018 ◽

Vol 92 (12) ◽

Author(s):

Adele Shenoy ◽

Andrew Dwork ◽

Mitchell S. V. Elkind ◽

Randolph Marshall ◽

Susan Morgello ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

T Cells ◽

T Cell ◽

Immunohistochemical Analysis ◽

Large Artery ◽

Arterial Remodeling ◽

Cd4 Counts ◽

Brain Arteries ◽

Increased Risk ◽

Immunodeficiency Virus

ABSTRACTThe pathogenesis of increased stroke risk in human immunodeficiency virus (HIV) remains unclear. Our study investigated the relationship between adventitial and intimal CD3+T cells and brain arterial remodeling that potentially contributes to HIV-related vasculopathy and stroke. Large brain arteries from 84 HIV+cases and 78 HIV−cases were analyzed to determine interadventitial and luminal diameters, intimal and wall thickness, percent stenosis, and the presence of atherosclerosis. Immunohistochemical analysis was performed to detect and visually score CD3, a pan-T-cell marker, in the intima and adventitia. Our study showed that numbers of adventitial CD3+T cells are lower among persons with HIV than among those without HIV, especially if CD4 counts are <200, though intimal CD3+T cell numbers did not differ by HIV status. Among those with HIV but CD4 counts of <200 at the time of death, intimal CD3+T cells were associated with hypertrophic outward remodeling, while among those with HIV and CD4 of >200 or HIV−controls, intimal CD3+T cells were associated with hypertrophic inward remodeling. We conclude that intimal lymphocytic inflammation is involved in brain arterial remodeling that may contribute to HIV-related cerebrovascular pathology.IMPORTANCEAlthough mortality from human immunodeficiency virus (HIV) has decreased with the use of combination antiretroviral therapies, there is now an increased risk of cardiovascular and cerebrovascular disease associated with HIV. Thus, there is a need to understand the pathogenesis of stroke in HIV infection. Our study examines how lymphocytic inflammation in brain arteries may contribute to increased cerebral vasculopathy. With this understanding, our study can potentially help direct future therapies to target and prevent brain arterial remodeling processes associated with HIV.

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Interest of NT-proBNP To Detect Chemotherapy Regimens Cardiotoxicity in Patients with Hematological Malignancies: Preliminary Results.

Blood ◽

10.1182/blood.v106.11.1331.1331 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1331-1331

Author(s):

Gerard Dine ◽

Vincent Genty ◽

Said Brahimi ◽

Nadia Ali Ammar ◽

William Mendes ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Diseases ◽

Natriuretic Peptide ◽

Hematological Malignancies ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Plasma Fraction ◽

Increased Risk ◽

The Mean

Abstract The potential cardiotoxicity of chemotherapic drugs is well known. For example anthracycline-based regimens are extremely effective for various hematological malignancies. The main disadvantage is cardiotoxicity particularly, in elderly patients who are frequently treated with a consequent dose reduction. The diagnosis and prognosis in patients with suspected heart failure needs a specific monitoring by echocardiography during and after chemotherapy regimens. We tested the interest of NT-proBNP as alternative marker for the detection of left ventricular dysfunction. Brain or B-type natriuretic peptide (BNP) and N-terminal fragment of B-type natriuretic peptide (NT-proBNP) are considered to be valuable biomarkers for the detection of disease state in patients with suspected heart failure. Methods During 1 year, blood samples of 31 patients with hematological malignancies, treated with usual chemotherapy were selected on a routine basis. Patients had the diagnosis of acute leukemia (AL), B-chronic lymphocytic leukemia (B-CLL), multiple myeloma (MM) and non Hodgkin lymphoma (NHL). Venous blood was drawn in the early morning and centrifuged at 2000 g for 15 minutes. The obtained clear plasma fraction was stored at −20°C until the assay. All plasma samples were analyzed for NT-proBNP using an electro chemiluminescence immuno assay (proBNP kit Roche Diagnostics, Mannheim, Germany) on Elecsys 2010 analyser. All assays were performed blind to clinical informations on the patients. Results The mean age of the patients was 72 (range: 36–88). There were 15 men (48 %) and 16 women (52 %). Five patients were smokers (16 %) and 7 (22.6%) had cardiovascular diseases (4 hypertension, 2 heart failure, 1 pace maker). Only 3 patients had a subnormal renal function. There were 6 patients with AL, 6 with B-CLL, 11 with MM and 8 with NHL. The administered medications were divided in 3 cardio-toxicity stages: 10 (32.25 %) patients received stage 3 cardiotoxicity regimens, 10 (32.25 %) stage 2 and 11 (35.5 %) stage 1. Fourteen patients (45 %) died in relation with hematological malignancies and none in relation with heart failure. But treatment regimens have been reduced, discontinued, modified or stopped in 7 patients after heart failure diagnosis with echocardiography. All these patients received stage 2 or 3 cardiotoxicity chemotherapy regimens and 4 had prior cardiovascular diseases. The mean age was 74 (range: 66–82). Only one patient is alive in this subgroup. Considering the age and the heart state of our 31 patients, chemotherapeutic treatments need or not to be adjust. The cardiac risk at diagnosis was assessed by left-ventricular ejection fraction (VEF) measurement. We shows that NT-proBNP brings reliable results to assess that risk, with a positive correlation to the VEF. Figure Figure Conclusion Despite the limitations of this preliminary study the measurement of the NT-proBNP concentration at baseline and during cardiotoxic regimens in patients with hematological malignancies seems to be a promising method to identify patients with an increased risk of cardiovascular adverse effects for it evolves earlier than VEF and is very well correlate to VEF loss and cardiotoxicity.

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Heart failure in human immunodeficiency virus-infected patients

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-1-3706 ◽

2020 ◽

Vol 25 (1) ◽

pp. 26-32

Author(s):

O. G. Goryacheva ◽

A. N. Koziolova

Keyword(s):

Heart Failure ◽

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Clinical Picture ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Immunodeficiency Virus ◽

Group 2 ◽

Relationship Of ◽

Group 1

Aim. To determine the features of heart failure (HF) development in patients with human immunodeficiency virus (HIV) infection.Material and methods. In a general hospital, 160 patients were examined during the year. All of them were divided into 2 groups: group 1 (n=100) — HIV-infected patients with specific clinical picture of HF; group 2 (n=60) — patients without HIV infection and with HF verified by echocardiography and concentration of N-terminal prohormone of brain natriuretic peptide (NT-proBNP).Results. In comparison with group 2, HIV-infected patients had the following statistically significant differences: lower left ventricular ejection fraction (LVEF), lower prevalence and severity of left ventricle diastolic dysfunction, higher LV mass index (LVMI), and lower NT-proBNP. HIV-infected patients had statistically significant moderate inverse relationship of LVEF (r=-0,43; p=0,015), E/e’ (r=-0,32; p=0,045), LVMI (r=-0,46; p=0,002) and strong relationship of NT-proBNP (r=-0,54; p<0,001) with CD4 T-lymphocyte count in 1 mm3 in the presence of HF symptoms and signs and an increase in NT-proBNP over 125 pg/ml. In group 1, there was a significantly higher prevalence of smoking, chronic alcoholism, drug use, chronic hepatitis C and cirrhosis (especially manifested by hepatomegaly and splenomegaly in combination with ascites and hepatic cytolysis), chronic pancreatitis, pneumonia and inflammatory diseases accompanied by higher erythrocyte sedimentation rate and C-reactive protein concentration, and lower hemoglobin level. HIV-infected patients were statistically less likely to use all groups of drugs for HF treatment, with the exception of spironolactone, and more likely to use drugs for multimorbidity treatment.Conclusion. The HF prevalence in hospitalized HIV-infected patients, estimated on the basis of symptoms and NT-proBNP increase >125 pg/ml, was 54%; on the basis of LVEF decrease <50% — 32%. The clinical picture of HIV-infected patients is characterized by various symptoms, including those typical for HF with normal NT-proBNP level, due to the high prevalence of comorbidities and concurrent medication.

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Abstract MP091: Hypertension is Associated With Increased Risk of Adverse Clinical Outcomes in Women With Peripartum Cardiomyopathy

Circulation ◽

10.1161/circ.135.suppl_1.mp091 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Tasnim F Imran ◽

Donya Mohebali ◽

Diana Lopez ◽

Natalie Bello ◽

Sandy Truong ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Transplantation ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

Left Ventricular Ejection ◽

Extra Corporeal Membrane Oxygenation ◽

Membrane Oxygenation ◽

Increased Risk

Background: Peripartum cardiomyopathy (PPCM) is a rare condition that carries a high morbidity and mortality among young women. Studies examining the association of modifiable risk factors such as hypertension with outcomes in this population are sparse. Methods: We conducted a multi-center retrospective study across three major centers (BWH, BIDMC, MGH) to identify subjects with PPCM using the following criteria: ejection fraction < 40%, development of heart failure within the last month of pregnancy or within 5 months of delivery and no other identifiable cause of heart failure with reduced ejection fraction. We defined adverse clinical outcome as a composite of heart failure hospitalizations, need for extra-corporeal membrane oxygenation, ejection fraction <35%, cardiac transplantation or death during the follow-up period. Results: In all, 237 women met criteria for PPCM across the three centers between April 1995 and November 2015. Participants had a median age of 33.1 years (IQR: 28.6-38.0), gravida 2.0, para 2.0, mean left ventricular ejection fraction at diagnosis of 30%; 25% had chronic hypertension and 14% had preeclampsia. After a median follow-up of 3.2 years (IQR: 1.0-7.8), 59 events occurred. In a logistic regression model adjusting for age, number of prior pregnancies and number of deliveries, women with preeclampsia had an OR of 1.34 (95% CI: 1.05-1.72), p=0.02 as compared to those without preeclampsia. A similar association was observed for hypertension (Table). In sensitivity analysis, the association between preeclampsia and adverse outcomes persisted for blacks and other races, but not for whites. Conclusion: Our study suggests that hypertension or preeclampsia at diagnosis is associated with increased risk of heart failure hospitalizations, need for extra-corporeal membrane oxygenation, poor left ventricular function recovery, cardiac transplantation and death on follow-up in women with PPCM. Clinicians should consider aggressive treatment of hypertension in women of childbearing age.

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P1595 Prognostic role of late gadolinium enhancement for sudden cardiac death risk in non-ischemic dilated cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1013 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Rodriguez Sanchez ◽

J J Onaindia ◽

V Gomez ◽

U Aguirre Larrakoetxea ◽

S Velasco ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Mortality ◽

Composite Endpoint ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Heart Failure Hospitalization ◽

Ventricular Ejection Fraction ◽

Non Ischemic Dilated Cardiomyopathy

Abstract OBJECTIVES to evaluate the prognosis role of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (cMRI) in patients with non-ischemic dilated cardiomyopathy (NIDM). BACKGROUND Risk stratification in NIDM needs to be improved. METHODS We included 210 patients with NIDM and cMRI from 2005 to 2018 in our study population. Outcomes were retrospectively assessed by medical records. The pattern of LGE was classified as mid-wall, sub-epicardial, or both patterns. Primary endpoint was sudden cardiac death (SCD) or aborted SCD. Secondary endpoints were global mortality and a composite endpoint of cardiovascular mortality and heart failure hospitalization. Demographic and clinical parameters were also evaluated. Patients with LGE (LGE+) were more likely to be male (80,6% vs 66,7%, p= 0,03). No significant differences were observed between LGE+ and LGE- patients in comorbidities, NYHA class, left ventricular ejection fraction (LVEF), or neurohormonal treatment. RESULTS Of 210 patients (71,4% men, median age 59,8 years) with a median follow up of 5,6 years (3,24-8,15), 72 patients (34,3%) had non ischemic LGE (LGE+) on cMRI. Mean left ventricular ejection fraction (LVEF) was 34%. SCD or aborted SCD occurred in 11 patients (5,2%): 6 patients (9,5%) with LGE+ vs 5 patients (4,07 %) of LGE- (p = 0,19). Patients with LGE+ had a higher risk for the composite endpoint (cardiovascular mortality and heart failure hospitalization): OR 2,45, confidence interval (CI): 1,16-5,17, (p = 0,02). LGE presence was not associated with global mortality. The subepicardial pattern of LGE was associated with SCD or aborted SCD. 3 out of 11 patients (27%), with subepicardial pattern of LGE suffered from SCD or aborted SCD (p= 0,01). CONCLUSIONS In our cohort of 210 patients with NIDM, LGE was not significatively associated with SCD or aborted SCD, probably because of a low event rate (5,2%) in a relatively small and well treated population, despite a long follow-up (5,6 years). On the other hand, LGE presence was associated with a higher risk for the composite endpoint of cardiovascular mortality and heart failure hospitalization. Finally, the subepicardial pattern of LGE identified a group of patients at high risk of SCD and aborted SCD.

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