Phenotype, outcomes and natural history of early-stage non-ischaemic cardiomyopathy.

Autor: Hammersley DJ; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Jones RE; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.; Anglia Ruskin Medical School, UK, Cambridge, UK.; Essex Cardiothoracic Centre, Basildon, UK., Owen R; London School of Hygiene and Tropical Medicine, London, UK., Mach L; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Lota AS; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Khalique Z; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., De Marvao A; Department of Women and Children's Health, King's College London, London, UK.; British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK., Androulakis E; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Hatipoglu S; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Gulati A; Lewisham and Greenwich NHS Trust, London, UK., Reddy RK; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Yoon WY; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Talukder S; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Shah R; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Baruah R; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Guha K; Portsmouth Hospitals NHS Trust, Portsmouth, UK., Pantazis A; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Baksi AJ; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Gregson J; London School of Hygiene and Tropical Medicine, London, UK., Cleland JGF; British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK., Tayal U; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Pennell DJ; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Ware JS; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.; MRC London Institute of Medical Sciences, Imperial College London, London, UK., Halliday BP; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK., Prasad SK; National Heart and Lung Institute, Imperial College London, London, UK.; Royal Brompton & Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2023 Nov; Vol. 25 (11), pp. 2050-2059. Date of Electronic Publication: 2023 Oct 11.
DOI: 10.1002/ejhf.3037
Abstrakt: Aims: To characterize the phenotype, clinical outcomes and rate of disease progression in patients with early-stage non-ischaemic cardiomyopathy (early-NICM).
Methods and Results: We conducted a prospective observational cohort study of patients with early-NICM assessed by late gadolinium enhancement cardiovascular magnetic resonance (CMR). Cases were classified into the following subgroups: isolated left ventricular dilatation (early-NICM H-/D+), non-dilated left ventricular cardiomyopathy (early-NICM H+/D-), or early dilated cardiomyopathy (early-NICM H+/D+). Clinical follow-up for major adverse cardiovascular events (MACE) included non-fatal life-threatening arrhythmia, unplanned cardiovascular hospitalization or cardiovascular death. A subset of patients (n = 119) underwent a second CMR to assess changes in cardiac structure and function. Of 254 patients with early-NICM (median age 46 years [interquartile range 36-58], 94 [37%] women, median left ventricular ejection fraction [LVEF] 55% [52-59]), myocardial fibrosis was present in 65 (26%). There was no difference in the prevalence of fibrosis between subgroups (p = 0.90), however fibrosis mass was lowest in early-NICM H-/D+, higher in early-NICM H+/D- and highest in early-NICM H+/D+ (p = 0.03). Over a median follow-up of 7.9 (5.5-10.0) years, 28 patients (11%) experienced MACE. Non-sustained ventricular tachycardia (hazard ratio [HR] 5.1, 95% confidence interval [CI] 2.36-11.00, p < 0.001), myocardial fibrosis (HR 3.77, 95% CI 1.73-8.20, p < 0.001) and diabetes mellitus (HR 5.12, 95% CI 1.73-15.18, p = 0.003) were associated with MACE in a multivariable model. Only 8% of patients progressed from early-NICM to dilated cardiomyopathy with LVEF <50% over a median of 16 (11-34) months.
Conclusion: Early-NICM is not benign. Fibrosis develops early in the phenotypic course. In-depth characterization enhances risk stratification and might aid clinical management.
(© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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