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Aim <p>To evaluate the impact of the 2023 Dutch national guidelines for primary prevention implantable cardioverter-defibrillator (ICD) implantation on outcomes in non-ischaemic cardiomyopathy (NICM) patients and to assess the role of late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) in predicting ICD therapy.</p> Methods <p>This retrospective, single-centre observational exploratory cohort study included patients with NICM who received a&#xa0;primary prevention single-chamber, dual-chamber or subcutaneous ICD between January 2008 and April 2022 and underwent LGE-CMR prior to implantation. Patients were classified into LGE+ and LGE− groups based on the presence of late enhancement detected by CMR. The primary endpoint was time to first appropriate ICD therapy. The secondary endpoint was all-cause mortality.</p> Results <p>Of the 258 NICM patients in the database, a&#xa0;total of 85&#xa0;patients were included, of whom 41&#xa0;had LGE on CMR. After a&#xa0;5-year follow-up period, appropriate ICD therapy occurred in 20% of the patients in the LGE+ group and 14% of patients in the LGE− group (<i>p</i> = 0.37). All-cause mortality was 7% in the LGE+ group and 14% in the LGE− group (<i>p</i> = 0.46). Multivariable analysis showed no parameters significantly associated with appropriate ICD therapy.</p> Conclusion <p>Applying the 2023 national guidelines retrospectively on a&#xa0;population of NICM patients with a&#xa0;primary prevention ICD indication demonstrated no significant association between LGE on CMR and appropriate ICD therapy over a&#xa0;follow-up period of 5&#xa0;years. These findings underscore the need for further research and randomised trials to refine risk stratification and ICD implantation guidelines in NICM, ideally leveraging a&#xa0;multicentre approach to address current limitations in sample size and enhance the generalisability of the results.</p>

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Prognostic value of late gadolinium enhancement cardiac MRI for ICD therapy in non-ischaemic cardiomyopathy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月25日

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  • Luuk H. G. A. Hopman,
  • Marthe A. J. Becker,
  • Sanna H. M. de Haas,
  • Anne-Lotte C. J. van der Lingen,
  • Mischa T. Rijnierse,
  • Pranav Bhagirath,
  • Michiel J. J. M. Zumbrink,
  • Louise R. A. Olde Nordkamp,
  • Lourens F. H. J. Robbers,
  • Marco J. W. Götte,
  • Vokko P. van Halm,
  • Cornelis P. Allaart

摘要

Aim

To evaluate the impact of the 2023 Dutch national guidelines for primary prevention implantable cardioverter-defibrillator (ICD) implantation on outcomes in non-ischaemic cardiomyopathy (NICM) patients and to assess the role of late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) in predicting ICD therapy.

Methods

This retrospective, single-centre observational exploratory cohort study included patients with NICM who received a primary prevention single-chamber, dual-chamber or subcutaneous ICD between January 2008 and April 2022 and underwent LGE-CMR prior to implantation. Patients were classified into LGE+ and LGE− groups based on the presence of late enhancement detected by CMR. The primary endpoint was time to first appropriate ICD therapy. The secondary endpoint was all-cause mortality.

Results

Of the 258 NICM patients in the database, a total of 85 patients were included, of whom 41 had LGE on CMR. After a 5-year follow-up period, appropriate ICD therapy occurred in 20% of the patients in the LGE+ group and 14% of patients in the LGE− group (p = 0.37). All-cause mortality was 7% in the LGE+ group and 14% in the LGE− group (p = 0.46). Multivariable analysis showed no parameters significantly associated with appropriate ICD therapy.

Conclusion

Applying the 2023 national guidelines retrospectively on a population of NICM patients with a primary prevention ICD indication demonstrated no significant association between LGE on CMR and appropriate ICD therapy over a follow-up period of 5 years. These findings underscore the need for further research and randomised trials to refine risk stratification and ICD implantation guidelines in NICM, ideally leveraging a multicentre approach to address current limitations in sample size and enhance the generalisability of the results.