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Setti M, Merlo M, Gigli M, Munaretto L, Paldino A, Stolfo D, Pio Loco C, Medo K, Gregorio C, De Luca A, Graw S, Castrichini M, Cannatà A, Ribichini FL, Dal Ferro M, Taylor M, Sinagra G, Mestroni L. Role of arrhythmic phenotype in prognostic stratification and management of dilated cardiomyopathy. Eur J Heart Fail 2024. [PMID: 38404225 DOI: 10.1002/ejhf.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/22/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
AIMS Dilated cardiomyopathy (DCM) with arrhythmic phenotype combines phenotypical aspects of DCM and predisposition to ventricular arrhythmias, typical of arrhythmogenic cardiomyopathy. The definition of DCM with arrhythmic phenotype is not universally accepted, leading to uncertainty in the identification of high-risk patients. This study aimed to assess the prognostic impact of arrhythmic phenotype in risk stratification and the correlation of arrhythmic markers with high-risk arrhythmogenic gene variants in DCM patients. METHODS AND RESULTS In this multicentre study, DCM patients with available genetic testing were analysed. The following arrhythmic markers, present at baseline or within 1 year of enrolment, were tested: unexplained syncope, rapid non-sustained ventricular tachycardia (NSVT), ≥1000 premature ventricular contractions/24 h or ≥50 ventricular couplets/24 h. LMNA, FLNC, RBM20, and desmosomal pathogenic or likely pathogenic gene variants were considered high-risk arrhythmogenic genes. The study endpoint was a composite of sudden cardiac death and major ventricular arrhythmias (SCD/MVA). We studied 742 DCM patients (45 ± 14 years, 34% female, 410 [55%] with left ventricular ejection fraction [LVEF] <35%). During a median follow-up of 6 years (interquartile range 1.6-12.1), unexplained syncope and NSVT were the only arrhythmic markers associated with SCD/MVA, and the combination of the two markers carried a significant additive risk of SCD/MVA, incremental to LVEF and New York Heart Association class. The probability of identifying an arrhythmogenic genotype rose from 8% to 30% if both early syncope and NSVT were present. CONCLUSION In DCM patients, the combination of early detected NSVT and unexplained syncope increases the risk of life-threatening arrhythmic outcomes and can aid the identification of carriers of malignant arrhythmogenic genotypes.
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Affiliation(s)
- Martina Setti
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Marta Gigli
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Laura Munaretto
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Alessia Paldino
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carola Pio Loco
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Kristen Medo
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Caterina Gregorio
- Biostatistics Unit, University of Trieste, Trieste, Italy
- MOX-Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Antonio De Luca
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Sharon Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matteo Castrichini
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Antonio Cannatà
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
- Department of Cardiovascular Sciences, King's College London, London, UK
| | | | - Matteo Dal Ferro
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Matthew Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Setti M, Merlo M, Gigli M, Munaretto L, Paldino A, Stolfo D, Loco CP, Medo K, Barbati G, Graw S, Ribichini FL, Ferro MD, Taylor M, Sinagra G, Mestroni L. 207 RE-DEFINING ARRHYTHMOGENIC CARDIOMYOPATHY: CHARACTERIZATION AND LONG-TERM PROGNOSTIC IMPLICATIONS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Arrhythmogenic dilated cardiomyopathy (AR-DCM) combines phenotypical aspects of dilated cardiomyopathy (DCM) and risk of sudden cardiac death (SCD), typical of the arrhythmogenic form (ACM). However, AR-DCM is often ambiguously defined leaving clinicians uncertain on how to identify these high-risk patients.
The aims of the study were to re-define AR-DCM based on outcome related arrhythmic markers and to test the usefulness of the novel AR-DCM definition in identifying arrhythmogenic genotypes (i.e., LMNA, FLNC, RBM20, and desmosomal genes).
Materials and methods
Consecutive DCM patients with genetic evaluation and Holter ECG monitoring or telemetry in two referral institution were analyzed. The arrhythmic markers tested to define AR-DCM were: SCD or major ventricular arrhythmias (MVA), unexplained syncope, rapid nonsustained ventricular tachycardia (nsTV), ≥1000 premature ventricular contractions/24 hours, or ≥50 ventricular couplets/24 hours. Patients were labeled as Early AR-DCM if criteria were met within 12 months from enrolment. The primary endpoint was a composite of SCD/MVA; the secondary endpoint was a composite of all-cause mortality/heart transplant/LVAD implantation (D/HTx/LVAD).
Results
Among the 743 DCM patients included, 290 had disease-related variants (39%), 94 (30%) of these carried arrhythmogenic genotype. Early AR-DCM was identified in 429 (58%) patients. During a median follow-up of 7.0 [2.2-13.8] years, among arrhythmic markers the occurrence of syncope and/or nsVT within 12 months from enrolment were the only arrhythmic markers independently associated with SCD/MVA (Figure), while the occurrence of early MVA and/or nsTV emerged as the strongest long-term predictors of D/ HTx/LVAD. Family history of MVA was also independently associated with primary and secondary endpoints, and together with MVA, nsTV or unexplained syncope increased the agreement between AR-DCM and arrhythmogenic genotypes in 1 out 2 patients.
Conclusions
A combination of early (i.e., within 1 year from diagnosis) MVA or nsVT or unexplained syncope might be proposed as a clinically useful new definition of AR-DCM, especially if associated to family history of MVA. This definition in fact allows clinicians to anticipates worse long-term arrhythmic and global outcomes, and to accurately identify malignant arrhythmogenic genotypes.
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Affiliation(s)
- Martina Setti
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
| | - Marco Merlo
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Marta Gigli
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Laura Munaretto
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Alessia Paldino
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Davide Stolfo
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Carola Pio Loco
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Kristen Medo
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
| | | | - Sharon Graw
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
| | | | - Matteo Dal Ferro
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Matthew Taylor
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
| | - Gianfranco Sinagra
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Luisa Mestroni
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
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Cannata A, Manca P, Nuzzi V, Gregorio C, Artico J, Gentile P, Pio Loco C, Ramani F, Barbati G, Merlo M, Sinagra G. Sex-Specific Prognostic Implications in Dilated Cardiomyopathy After Left Ventricular Reverse Remodeling. J Clin Med 2020; 9:jcm9082426. [PMID: 32751220 PMCID: PMC7464387 DOI: 10.3390/jcm9082426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Women affected by Dilated Cardiomyopathy (DCM) experience better outcomes compared to men. Whether a more pronounced Left Ventricular Reverse Remodelling (LVRR) might explain this is still unknown. AIM We investigated the relationship between LVRR and sex and its long-term outcomes. METHODS A cohort of 605 DCM patients with available follow-up data was consecutively enrolled. LVRR was defined, at 24-month follow-up evaluation, as an increase in left ventricular ejection fraction (LVEF) ≥ 10% or a LVEF > 50% and a decrease ≥ 10% in indexed left ventricular end-diastolic diameter (LVEDDi) or an LVEDDi ≤ 33 mm/m2. Outcome measures were a composite of all-cause mortality/heart transplantation (HTx) or ventricular assist device (VAD) and a composite of Sudden Cardiac Death (SCD) or Major Ventricular Arrhythmias (MVA). RESULTS 181 patients (30%) experienced LVRR. The cumulative incidence of LVRR at 24-months evaluation was comparable between sexes (33% vs. 29%; p = 0.26). During a median follow-up of 149 months, women experiencing LVRR had the lowest rate of main outcome measure (global p = 0.03) with a 71% relative risk reduction compared to men with LVRR, without significant difference between women without LVRR and males. A trend towards the same results was found regarding SCD/MVA (global p = 0.06). Applying a multi-state model, male sex emerged as an independent adverse prognostic factor even after LVRR completion. CONCLUSIONS Although the rate of LVRR was comparable between sexes, females experiencing LVRR showed the best outcomes in the long term follow up compared to males and females without LVRR. Further studies are advocated to explain this difference in outcomes between sexes.
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Affiliation(s)
- Antonio Cannata
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy; (A.C.); (P.M.); (V.N.); (J.A.); (P.G.); (C.P.L.); (F.R.); (G.S.)
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE5 9NU, UK
| | - Paolo Manca
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy; (A.C.); (P.M.); (V.N.); (J.A.); (P.G.); (C.P.L.); (F.R.); (G.S.)
| | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy; (A.C.); (P.M.); (V.N.); (J.A.); (P.G.); (C.P.L.); (F.R.); (G.S.)
| | - Caterina Gregorio
- Biostatistics Unit, University of Trieste, 34100 Trieste, Italy; (C.G.); (G.B.)
| | - Jessica Artico
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy; (A.C.); (P.M.); (V.N.); (J.A.); (P.G.); (C.P.L.); (F.R.); (G.S.)
| | - Piero Gentile
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy; (A.C.); (P.M.); (V.N.); (J.A.); (P.G.); (C.P.L.); (F.R.); (G.S.)
| | - Carola Pio Loco
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy; (A.C.); (P.M.); (V.N.); (J.A.); (P.G.); (C.P.L.); (F.R.); (G.S.)
| | - Federica Ramani
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy; (A.C.); (P.M.); (V.N.); (J.A.); (P.G.); (C.P.L.); (F.R.); (G.S.)
| | - Giulia Barbati
- Biostatistics Unit, University of Trieste, 34100 Trieste, Italy; (C.G.); (G.B.)
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy; (A.C.); (P.M.); (V.N.); (J.A.); (P.G.); (C.P.L.); (F.R.); (G.S.)
- Correspondence: ; Tel.: +39-04-0399-4477; Fax: +39-04-0399-4878
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy; (A.C.); (P.M.); (V.N.); (J.A.); (P.G.); (C.P.L.); (F.R.); (G.S.)
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Merlo M, Cannatà A, Pio Loco C, Stolfo D, Barbati G, Artico J, Gentile P, De Paris V, Ramani F, Zecchin M, Gigli M, Pinamonti B, Korcova R, Di Lenarda A, Giacca M, Mestroni L, Camici PG, Sinagra G. Contemporary survival trends and aetiological characterization in non‐ischaemic dilated cardiomyopathy. Eur J Heart Fail 2020; 22:1111-1121. [DOI: 10.1002/ejhf.1914] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/23/2020] [Accepted: 05/22/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Marco Merlo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Antonio Cannatà
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine King's College London London UK
| | - Carola Pio Loco
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Davide Stolfo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | | | - Jessica Artico
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Piero Gentile
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Valerio De Paris
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Federica Ramani
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Massimo Zecchin
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Marta Gigli
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Bruno Pinamonti
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Renata Korcova
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Andrea Di Lenarda
- Cardiovascular Centre Azienda Sanitaria Universitaria Integrata of Trieste (ASUITS), University of Trieste Trieste Italy
| | - Mauro Giacca
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine King's College London London UK
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Paolo G. Camici
- Vita Salute University and San Raffaele Hospital Milan Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
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