ФАКТОРЫ РИСКА РАЗВИТИЯ НЕБЛАГОПРИЯТНЫХ СЕРДЕЧНО-СОСУДИСТЫХ СОБЫТИЙ У ПАЦИЕНТОВ С СОЧЕТАНИЕМ НЕКОМПАКТНОЙ И ДИЛАТАЦИОННОЙ КАРДИОМИОПАТИИ

Abstract

The objective is to identify factors associated with adverse cardiovascular events in a cohort of patients with a combination of non-compaction (NCCM) and dilated cardiomyopathy (DCM) in order to reveal high-risk patients. Materials and methods. 104 patients with a combination of NCCM and DCM aged 31 to 52 years (median age 41 years; 81 men; 23 women) were examined, who, in addition to traditional clinical research methods, underwent cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement. The endpoints of the study included progression of chronic heart failure (CHF) to functional class (FC) III NYHA requiring hospitalization, ventricular tachyarrhythmias and thromboembolic events. Results. During the 24-month follow-up period (from 7 to 183) adverse cardiovascular events were registered in 84 (80.7%) patients, of which progression of CHF to FC III NYHA – in 47 (45.2%). Univariate analysis showed that the following characteristics were independent risk factors for the progression of CHF: symptoms of CHF II FC at the initial examination (HR 15.4; 95% CI 1.9-125.3, p = 0.0002), male gender (HR 4.6; 95% CI 1.3-16.1, p = 0.01), LVEF < 40% (HR 1.3; 95% CI 1.1-1.4, p = 0.0004), an increase in left ventricular end-diastolic volume index (LV EDVI) (HR 1.02; 95% CI 1.01-1.04, p = 0.0262), an increase in left ventricular end-systolic volume index (LV ESVI) (HR 1.04; 95% CI 1.01-1.06, p = 0.0080), right ventricular fractional area change (RV FAC) (HR 0.9; 95% CI 0.8-1.0, p = 0.0478) according to transthoracic echocardiogram (TTE) data, a decrease in global longitudinal strain (GLS) level ≤ 11% (HR 4.7; 95% CI 1.2-17.4, p = 0.0207) according to 2D Strain and percentage of myocardial fibrosis according to CMR imaging with late gadolinium enhancement (HR 0.94; 95% CI 0.9-1.0, p = 0.0329). 26 (25.0%) patients developed ventricular tachyarrhythmias, associated with the following risk factors: premature ventricular contractions (PVCs) > 500 bpm (HR 45; 95% CI 7.5-751.2, p = 0.0005), a decrease in the GLS level ≤ 11% (HR 5.3; 95% CI 1.03-27.4, p = 0.0282) according to 2D Strain data. 11 (10.6%) developed embolic events, the predictors of which were: atrial fibrillation/flutter (HR 24; 95% CI 3.0-188.2, p = 0.0037), left atrium volume index (LAVI) (HR 32.2; 95% CI 1.2-956, p = 0.0352) and LVEF < 40% according to CMR (HR 1.33; 95% CI 1.03-1.7, p = 0.0269). Conclusion. Factors associated with the risk of adverse events are the presence at the initial examination of symptoms of FC II CH by NYHA, male gender, LVEF ≤ 40%, an increase in LAVI ≥ 57 ml/m2, a decrease in GLS ≤ 11%, the presence of myocardial fibrosis according to CMR imaging with late gadolinium enhancement, PVCs > 500 bpm according to 24-hour ECG monitoring, which can be used to identify patients at high risk of adverse cardiovascular events.