Abstract 17191: Fragmentation Assessed by Magnetocardiography but not Electrocardiogram Can Predict Future Cardiac Events in Patients with Non-ischemic Dilated Cardiomyopathy and Narrow QRS

Background: Fragmented QRS (fQRS) in 12-lead ECG, ascribed to myocardial scar, has been shown to predict future cardiac events in patients with both ischemic and non-ischemic dilated cardiomyopathy (NIDCM). Various definitions and low specificity of fQRS, however, limited its use. We hypothesized that the advantage of 64-channel magnetocardiography (MCG), i.e., high spatio-temporal resolution, enables more accurate detection of fragmented LV conduction (fLV), that would lead to accurate prediction of future events. Methods: In 51 patients with NIDCM and narrow QRS (LVEF, 22±7%; QRS duration, 99±11 ms), we recorded MCG. We defined, in MCG superimposed vector magnitude waveforms, fLV as distinct abnormal components (>20% of maximal amplitude). In current arrow map, fLV corresponded to heterogeneous QRS currents (Figure). We predicted major adverse cardiac events (MACE), including sudden cardiac death (SCD), sustained ventricular tachyarrhythmias (VF/VT), appropriate defibrillator discharge (Def) and left ventricular assist device implantation (LVAD). Results: fLV was present in 27 (Group-F) and not in 24 (Group-N). Age, gender, ECG and echocardiographic findings, laboratory data and medications were similar irrespective of fLV. During a mean follow-up of 2.2 years, MACE occurred in 19 (4 SCD, 9 VF/VT, 2 Def, and 4 LVAD). MACE more frequently occurred with fLV (63%, 17/27) than without (8%, 2/24, Kaplan-Meier analysis, p<0.001). Multivariate analysis revealed fLV as the only independent predictor of MACE (HR 4.82, p=0.015). Conclusion: MCG analysis is a promising noninvasive tool to accurately detect fragmentation and predict MACE in patients with NIDCM and normal QRS.

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P774Magnetocardiography can disclose delayed left ventricular conduction and predict cardiac events in non-ischemic dilated cardiomyopathy patients with narrow QRS

European Heart Journal ◽

10.1093/eurheartj/ehx501.p774 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

S. Kawakami ◽

H. Takaki ◽

S. Hashimoto ◽

T. Aiba ◽

K. Kusano ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Cardiac Events ◽

Narrow Qrs ◽

Non Ischemic Dilated Cardiomyopathy ◽

Ventricular Conduction

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Abstract 13785: Left Ventricular Contractile Entropy in 99mTc-Sestamibi SPECT is a Novel Prognostic Predictor in Patients with Non-ischemic Dilated Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.13785 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Naoaki Kano ◽

Takahiro Okumura ◽

Akinori Sawamura ◽

Naoki Watanabe ◽

Hiroaki Mori ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Sampling Point ◽

Cardiac Events ◽

Ventricular Ejection Fraction ◽

Qrs Duration ◽

Non Ischemic Dilated Cardiomyopathy ◽

The Mean ◽

99Mtc Sestamibi

Background: It has been reported that mechanical dispersion of myocardial contraction is increased in failing myocardium. However little is known about the association between contractile entropy evaluated by myocardial scintigraphy and prognosis in patients with non-ischemic dilated cardiomyopathy (NIDCM). Purpose: We aimed to investigate the prognostic value of contractile entropy in patients with NIDCM. Methods: Forty-seven patients (38 male, 55.1 years) with NIDCM were performed gated 99mTc-sestamibi myocardial perfusion SPECT (GMPS) and endomyocardial biopsy. Entropy was automatically calculated as a result of contractile phase analysis for each myocardial sampling point from GMPS, and it reflects a dispersion of global mechanical contraction. All patients were allocated into two groups based on the median of entropy; HE-group: entropy≥0.61 and LE-group: entropy<0.61. All patients were followed up at the mean of 2.8 years. Results: The mean QRS duration, left ventricular ejection fraction (LVEF) and plasma brain natriuretic peptide (BNP) levels were 114 msec, 35% and 225 pg/mL, respectively. Although there were no significant differences in QRS duration and plasma BNP levels between the two groups, LVEF was lower in the HE-group than in the LE-group (31.1% vs 39.8%, p=0.002). In Kaplan-Meier survival analysis, cardiac event rate was significantly higher in the HE-group (Figure). Cox proportional hazard analysis revealed that the HE-group was a significant determinant of cardiac events (Hazard Ratio: 7.66; 95%CI: 0.070-2.532; p=0.033). The mRNA expression level of sarcoplasmic endoplasmic reticulum Ca2+ ATPase (SERCA2a) in biopsy specimens was significantly lower in the LE-group (p=0.015). Conclusion: Contractile entropy, reflecting an impairment of global left ventricular contraction, might be useful to predict a poor prognosis in patients with NIDCM.

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Prognostic impact of multiple fragmented QRS on cardiac events in idiopathic dilated cardiomyopathy

EP Europace ◽

10.1093/europace/euaa193 ◽

2020 ◽

Author(s):

Kyohei Marume ◽

Teruo Noguchi ◽

Tsukasa Kamakura ◽

Emi Tateishi ◽

Yoshiaki Morita ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Cox Regression ◽

Left Ventricular ◽

Idiopathic Dilated Cardiomyopathy ◽

Left Ventricular Ejection ◽

Prognostic Impact ◽

Cardiac Events ◽

Ventricular Ejection Fraction ◽

Fragmented Qrs ◽

Kaplan Meier

Abstract Aims To evaluate the prognostic impact of fragmented QRS (fQRS) on idiopathic dilated cardiomyopathy (DCM). Methods and results We conducted a prospective observational study of 290 consecutive patients with DCM (left ventricular ejection fraction ≤ 40%) and narrow QRS who underwent cardiac magnetic resonance. We defined fQRS as the presence of various RSR′ patterns in ≥2 contiguous leads representing the anterior (V1–V5), inferior (II, III, and aVF), or lateral (I, aVL, and V6) myocardial segments. Multiple fQRS was defined as the presence of fQRS in ≥2 myocardial segments. Patients were divided into three groups: no fQRS, single fQRS, or multiple fQRS. The primary endpoint was a composite of hard cardiac events consisting of heart failure death, sudden cardiac death (SCD), or aborted SCD. The secondary endpoints were all-cause death and arrhythmic event. During a median follow-up of 3.8 years (interquartile range, 1.8–6.2), 31 (11%) patients experienced hard cardiac events. Kaplan–Meier analysis showed that the rates of hard cardiac events and all-cause death were similar in the single-fQRS and no-fQRS groups and higher in the multiple-fQRS group (P = 0.004 and P = 0.017, respectively). Multivariable Cox regression identified that multiple fQRS is a significant predictor of hard cardiac events (hazard ratio, 2.23; 95% confidence interval, 1.07–4.62; P = 0.032). The multiple-fQRS group had the highest prevalence of a diffuse late gadolinium enhancement pattern (no fQRS, 21%; single fQRS, 22%; multiple fQRS, 39%; P < 0.001). Conclusion Multiple fQRS, but not single fQRS, is associated with future hard cardiac events in patients with DCM.

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Reversible dilated cardiomyopathy: into the thaumaturgy of the heart - Part 1

Cardiogenetics ◽

10.4081/cardiogenetics.2016.5861 ◽

2016 ◽

Vol 6 (1) ◽

Author(s):

Giovanni Quarta ◽

Raffale Coppini ◽

Pier Lambiase ◽

Pablo Garcia-Pavia ◽

Alice Calabrese ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Morphological Changes ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Assist ◽

Device Implantation ◽

Lv Dysfunction ◽

Left Ventricular Assist ◽

Muscle Disorder ◽

Tako Tsubo Cardiomyopathy

Dilated cardiomyopathy (DCM) is a genetic or acquired heart muscle disorder characterized by dilation and impaired contraction of one or both ventricles. In the acquired forms of the disease, if the pathogenic agent is persistent, undiagnosed or untreated, permanent ultrastructural and morphological changes may lead to irreversible dysfunction. Conversely, when DCM is promptly recognized and treated, the heart may show an extraordinary ability to recover from left ventricular (LV) systolic dysfunction. While much research in heart failure has focused on morbidity and mortality associated with persistent LV systolic dysfunction, relatively little attention has been devoted to this remarkable potential for recovery. In this two-part review we will focus on the most common types of reversible DCM. The first part will deal with Tako-Tsubo cardiomyopathy, tachycardiainduced cardiomyopathy, metabolic DCM and recovery after Left ventricular assist device implantation. Although diverse in etiopathogenesis, genetic background, therapeutic options and outcome, the forms of DCM characterized by reversible LV dysfunction share similar challenges in diagnosis and clinical management. The identification of pathways to recovery may show the way for novel therapeutic targets ultimately benefitting all cardiac patients.

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358 Clinical characteristic and natural history of chemotherapy induced dilated cardiomyopathy

European Heart Journal Supplements ◽

10.1093/eurheartj/suab142.024 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Andrea Lalario ◽

Eva Del Mestre ◽

Michele Lo Casto ◽

Vincenzo Nuzzi ◽

Antonio Cannatà

Keyword(s):

Dilated Cardiomyopathy ◽

Cardiac Death ◽

Primary Outcome ◽

Multivariable Analysis ◽

Secondary Outcome ◽

Ventricular Assist ◽

Device Implantation ◽

Kaplan Meier ◽

History Of ◽

Clinical Characteristic

Abstract Chemotherapy can lead to chemotherapy-induced dilated cardiomyopathy (CI-DCM), recognized as one of the Non-ischaemic Dilated Cardiomyopathy (DCM) phenotypes characterized by worse outcome. Evidences on a direct comparison between idiopathic-DCM (iDCM) and CI-DCM still lack. We included all the consecutive patients enrolled in the Trieste Muscle Heart Disease Registry. C-DCM was defined according to current recommendations. Uni- and multivariable analysis and Kaplan-Meier were performed. The primary outcome was all-cause death and the secondary outcomes were cardiac death and a composite of heart failure hospitalization, heart transplantation, ventricular assist-device implantation and major ventricular arrhythmias. The study included 511 patients (499 patients affected by iDCM and 52 patients affected by CI-DCM). Compared to iDCM, CI-DCM patients were older (51 ± 14 years vs. 58 ± 3 years respectively, P < 0.001) and had a higher LVEF (35%±10 vs. 32%±9, P = 0.03). CI-DCM patients had a higher incidence of all-cause of death compared to iDCM (36.5% vs. 8.4%, P < 0.001), while the incidence of cardiac death (7% in the CI-DCM group vs. 4% in the iDCM group, P = 0. 232) and of the composite secondary outcome was comparable amongst the two groups. At multivariable analysis, the diagnosis of CI-DCM was an independent predictor of primary outcome incidence (HR: 5.79, 95% CI: 1.83–18.27), P = 0.003, together atrial fibrillation. In a well-selected DCM cohort, patients with a chemotherapic etiology had a higher incidence of all-cause mortality compared to iDCM, while the incidence of cardiac adverse events was comparable among CI-DCM and iDCM.

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