Abstract
BackgroundRisk stratification of patients with non-ischemic dilated cardiomyopathy remains a matter of debate in the era of device implantation.ObjectiveWe investigated associations between histopathological findings, contrast-enhanced cardiac MRI and the inducibility of ventricular tachycardia (VT) or fibrillation (VF) in programmed ventricular stimulation.Methods56 patients with impaired left ventricular ejection fraction (LVEF≤50%, mean 36.6±10.5%) due to non-ischemic dilated cardiomyopathy underwent cardiac MRI, programmed ventricular stimulation, and endomyocardial biopsy and were retrospectively investigated. Inducibility was defined as sustained mono- or polymorphic VT or unstable VT/VF requiring cardioversion/defibrillation. Primary study endpoint was defined as the occurrence of hemodynamically relevant VT/VF and/or adequate ICD-therapy during follow-up.ResultsEndomyocardial biopsy detected cardiac fibrosis in 18 (32.1%) patients. Cardiac MRI revealed 35 (62.5%) patients with positive late gadolinium enhancement. VT/VF was induced in ten (17.9%) patients during programmed ventricular stimulation. Monomorphic VT was inducible in 70%, while 20% of patients showed polymorphic VT. One patient (10%) presented with VF. Inducibility correlated significantly with the presence of positive late gadolinium enhancement in cardiac MRI (p<0.01). We could not find a significant association between inducibility and the degree of cardiac inflammation and fibrosis in non-site directed routine right ventricular endomyocardial biopsy. During a mean follow-up of 2.6 years, nine (16.1%) patients reached the primary endpoint. Monomorphic VTs were found in 66.7% patients and were terminated by antitachycardia pacing therapy. One patient with polymorphic VT and two patients with VF received adequate therapy by an ICD-shock. However, inducibility did not correlate with the occurrence of endpoints.ConclusionInducibilty during programmed ventricular stimulation is associated with positive late gadolinium enhancement in cardiac MRI of patients with non-ischemic dilated cardiomyopathy. The presence of myocardial fibrosis or inflammation in undirected endomyocardial biopsy does not seem to be sufficient to predict future ventricular arrhythmias.
Highlights
Non-ischemic dilated cardiomyopathy (NIDCM) is a common cause of congestive heart failure (HF) with the subsequent need for intensified pharmacological treatment, implantation of cardioverter-defibrillators (ICDs), therapy of ventricular tachycardias (VTs), or even heart transplantation
Inducibilty during programmed ventricular stimulation is associated with positive late gadolinium enhancement in cardiac magnetic resonance imaging (MRI) of patients with non-ischemic dilated cardiomyopathy
We retrospectively studied a cohort of n = 56 patients with impaired left ventricular ejection fraction (LVEF)
Summary
Non-ischemic dilated cardiomyopathy (NIDCM) is a common cause of congestive heart failure (HF) with the subsequent need for intensified pharmacological treatment, implantation of cardioverter-defibrillators (ICDs), therapy of ventricular tachycardias (VTs), or even heart transplantation. Several trials have shown that patients’ outcome benefits significantly from device implantation by reducing the incidence of sudden cardiac death in primary and secondary prevention but at considerable costs [2] and risks of complications associated with the implantation [3]. Up to 80% of NIDCM patients with an ICD and LVEF
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