Predictores de muerte súbita en miocardiopatía dilatada: más allá de la presencia de realce tardío de gadolinio

Abstract

Introduction and objectivesSudden cardiac death (SCD) risk stratification needs to be improved in patients with dilated cardiomyopathy (DCM). The aim of our study was to identify clinical and cardiac magnetic resonance predictors that could identify patients with DCM at higher risk of SCD. MethodsMulticenter, retrospective study. We included 386 patients with DCM and left ventricular ejection fraction <50%. The presence of late gadolinium enhancement (LGE) was evaluated and then characterized according to its pattern and location. Primary event was defined as a composite of SCD and aborted SCD. Events were assigned through clinical records review. ResultsAfter a 4.9-year follow-up (P25-75: 3.1-7.1) 27 primary events (6.98%) were registered. In multivariate models the following variables were associated with higher risk of the primary event: History of syncope, time since diagnosis of DCM> 1 year, LGE presence, subepicardial pattern of LGE, multiple coexisiting LGE patterns, LGE in multiple locations and biventricular ejection fraction <35%. Multivariate competing risk models showed C-index of 0.90 to 0.91 (95%CI, 0.84-0.96), with good calibration. ConclusionsIn patients with DCM, beyond LGE presence, clinical parameters (syncope and DCM evolution time> 1 year), characterization of LGE and biventricular ejection fraction <35% identified patients with DCM at higher risk of SCD/aborted SCD. Our SCD predictive competing risks models showed excellent accuracy. Further studies will be needed to confirm these results.