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Henkens MTHM, López Martínez H, Weerts J, Sammani A, Raafs AG, Verdonschot JAJ, van de Leur RR, Sikking MA, Stroeks S, van Empel VPM, Brunner‐La Rocca H, van Stipdonk AMW, Farmakis D, Hazebroek MR, Vernooy K, Bayés‐de‐Luna A, Asselbergs FW, Bayés‐Genís A, Heymans SRB. Interatrial Block Predicts Life-Threatening Arrhythmias in Dilated Cardiomyopathy. J Am Heart Assoc 2022; 11:e025473. [PMID: 35861818 PMCID: PMC9707810 DOI: 10.1161/jaha.121.025473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Background Interatrial block (IAB) has been associated with supraventricular arrhythmias and stroke, and even with sudden cardiac death in the general population. Whether IAB is associated with life-threatening arrhythmias (LTA) and sudden cardiac death in dilated cardiomyopathy (DCM) remains unknown. This study aimed to determine the association between IAB and LTA in ambulant patients with DCM. Methods and Results A derivation cohort (Maastricht Dilated Cardiomyopathy Registry; N=469) and an external validation cohort (Utrecht Cardiomyopathy Cohort; N=321) were used for this study. The presence of IAB (P-wave duration>120 milliseconds) or atrial fibrillation (AF) was determined using digital calipers by physicians blinded to the study data. In the derivation cohort, IAB and AF were present in 291 (62%) and 70 (15%) patients with DCM, respectively. LTA (defined as sudden cardiac death, justified shock from implantable cardioverter-defibrillator or anti-tachypacing, or hemodynamic unstable ventricular fibrillation/tachycardia) occurred in 49 patients (3 with no IAB, 35 with IAB, and 11 patients with AF, respectively; median follow-up, 4.4 years [2.1; 7.4]). The LTA-free survival distribution significantly differed between IAB or AF versus no IAB (both P<0.01), but not between IAB versus AF (P=0.999). This association remained statistically significant in the multivariable model (IAB: HR, 4.8 (1.4-16.1), P=0.013; AF: HR, 6.4 (1.7-24.0), P=0.007). In the external validation cohort, the survival distribution was also significantly worse for IAB or AF versus no IAB (P=0.037; P=0.005), but not for IAB versus AF (P=0.836). Conclusions IAB is an easy to assess, widely applicable marker associated with LTA in DCM. IAB and AF seem to confer similar risk of LTA. Further research on IAB in DCM, and on the management of IAB in DCM is warranted.
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Affiliation(s)
- Michiel T. H. M. Henkens
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
| | | | - Jerremy Weerts
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Arjan Sammani
- Department of CardiologyDivision of Heart and LungsUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Anne G. Raafs
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Job A. J. Verdonschot
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
- Department of clinical genetics, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Rutger R. van de Leur
- Department of CardiologyDivision of Heart and LungsUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Maurits A. Sikking
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Sophia Stroeks
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Vanessa P. M. van Empel
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
| | | | | | - Dimitrios Farmakis
- University of Cyprus Medical SchoolNicosiaCyprus
- Heart Failure UnitDepartment of CardiologyAttikon University HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Mark R. Hazebroek
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Kevin Vernooy
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Antoni Bayés‐de‐Luna
- Cardiovascular Research Foundation. Cardiovascular ICCC‐ ProgramResearch Institute Hospital de la Santa Creu i Sant PauIIB‐Sant PauBarcelonaSpain
| | - Folkert W. Asselbergs
- Department of CardiologyDivision of Heart and LungsUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Institute of Cardiovascular ScienceFaculty of Population Health SciencesUniversity College LondonLondonUK
- Health Data Research UK and Institute of Health InformaticsUniversity College LondonLondonUK
| | | | - Stephane R. B. Heymans
- Department of Cardiology, CARIMMaastricht University Medical CentreMaastrichtThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Department of Cardiovascular ResearchUniversity of LeuvenLeuvenBelgium
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Henkens MTHM, Weerts J, Verdonschot JAJ, Raafs AG, Stroeks S, Sikking MA, Amin H, Mourmans SGJ, Geraeds CBG, Sanders-van Wijk S, Barandiarán Aizpurua A, Uszko-Lencer NHMK, Krapels IPC, Wolffs PFG, Brunner HG, van Leeuwen REW, Verhesen W, Schalla SM, van Stipdonk AWM, Knackstedt C, Li X, Abdul Hamid MA, van Paassen P, Hazebroek MR, Vernooy K, Brunner-La Rocca HP, van Empel VPM, Heymans SRB. Improving diagnosis and risk stratification across the ejection fraction spectrum: the Maastricht Cardiomyopathy registry. ESC Heart Fail 2022; 9:1463-1470. [PMID: 35118823 PMCID: PMC8934928 DOI: 10.1002/ehf2.13833] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/04/2021] [Revised: 01/05/2022] [Accepted: 01/18/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Heart failure (HF) represents a clinical syndrome resulting from different aetiologies and degrees of heart diseases. Among these, a key role is played by primary heart muscle disease (cardiomyopathies), which are the combination of multifactorial environmental insults in the presence or absence of a known genetic predisposition. The aim of the Maastricht Cardiomyopathy registry (mCMP-registry; NCT04976348) is to improve (early) diagnosis, risk stratification, and management of cardiomyopathy phenotypes beyond the limits of left ventricular ejection fraction (LVEF). METHODS AND RESULTS The mCMP-registry is an investigator-initiated prospective registry including patient characteristics, diagnostic measurements performed as part of routine clinical care, treatment information, sequential biobanking, quality of life and economic impact assessment, and regular follow-up. All subjects aged ≥16 years referred to the cardiology department of the Maastricht University Medical Center (MUMC+) for HF-like symptoms or cardiac screening for cardiomyopathies are eligible for inclusion, irrespective of phenotype or underlying causes. Informed consented subjects will be followed up for 15 years. Two central approaches will be used to answer the research questions related to the aims of this registry: (i) a data-driven approach to predict clinical outcome and response to therapy and to identify clusters of patients who share underlying pathophysiological processes; and (ii) a hypothesis-driven approach in which clinical parameters are tested for their (incremental) diagnostic, prognostic, or therapeutic value. The study allows other centres to easily join this initiative, which will further boost research within this field. CONCLUSIONS The broad inclusion criteria, systematic routine clinical care data-collection, extensive study-related data-collection, sequential biobanking, and multi-disciplinary approach gives the mCMP-registry a unique opportunity to improve diagnosis, risk stratification, and management of HF and (early) cardiomyopathy phenotypes beyond the LVEF limits.
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Affiliation(s)
- Michiel T H M Henkens
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Netherlands Heart Institute (NLHI), Utrecht, The Netherlands.,Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jerremy Weerts
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Job A J Verdonschot
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anne G Raafs
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sophia Stroeks
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maurits A Sikking
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hesam Amin
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sanne G J Mourmans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Chrit B G Geraeds
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sandra Sanders-van Wijk
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | | | | | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rick E W van Leeuwen
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wouter Verhesen
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Simon M Schalla
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Christian Knackstedt
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Xiaofei Li
- Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Myrurgia A Abdul Hamid
- Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mark R Hazebroek
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Vanessa P M van Empel
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiovascular Research, University of Leuven, Leuven, Belgium
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