Prognosis and Risk Stratification in Dilated Cardiomyopathy With LVEF≤35%: Cardiac MRI Insights for Better Outcomes

作者：Di Zhou, Leyi Zhu, Shuang Li, Weichun Wu, Baiyan Zhuang, Jing Xu, Wenjing Yang, Jian He, Yining Wang, Yuhui Zhang, Guanshu Liu, Xiaoxin Sun, Qiang Zhang, Zhongzhao Teng, Arlene Sirajuddin, Andrew E. Arai, Shihua Zhao, Minjie Lu · 发表于：Circulation Cardiovascular Imaging · 年份：2025 · DOI：10.1161/circimaging.124.017246 · 被引用次数：6 · 研究领域：Cardiac Imaging and Diagnostics、Cardiac pacing and defibrillation studies、Advanced MRI Techniques and Applications

BACKGROUND: Current guidelines recommend implantable cardioverter defibrillators for the primary prevention of sudden cardiac death (SCD) in patients with dilated cardiomyopathy with left ventricular ejection fraction (LVEF)≤35%. However, its effectiveness is hindered by the inability to reliably discriminate between the risk of SCD and competing death of heart failure deterioration, thereby limiting its clinical utility. We aimed to refine the SCD risk stratification model based on cardiac magnetic resonance imaging for patients with dilated cardiomyopathy with LVEF≤35%. METHODS: A total of 1272 patients with dilated cardiomyopathy with LVEF≤35% who underwent cardiac magnetic resonance imaging were consecutively enrolled in this study. The primary end point is a composite of SCD or aborted SCD and the second end point is a composite of heart failure death and heart transplantation. RESULTS: Over a median follow-up of 86.3 months, 101 patients reached the primary end point. In the adjusted analysis, age (hazard ratio [HR], 1.02 [95% CI, 1.01–1.04]; P =0.006) years, a family history of SCD (HR, 2.00 [95% CI, 1.01–3.98]; P =0.05), NT-proBNP (N-terminal pro-B-type natriuretic peptide) (HR, 2.02 [95% CI, 1.18–3.44]; P =0.01), LVEF (per 5% HR, 0.79 [95% CI, 0.66–0.95]; P =0.01), and late gadolinium enhancement≥7.5% (HR, 4.11[95% CI, 2.72–6.21]; P <0.001) were associated with SCD or aborted SCD. Left atrial volume index≥68.3 mL/m 2 was an independent predictor of the secondary e...