CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: an international Registry
Authors: Guaricci Andrea Igoren , Masci Pier Giorgio , Muscogiuri Giuseppe , Guglielmo Marco , Baggiano Andrea , Fusini Laura , Lorenzoni Valentina , Martini Chiara , Andreini Daniele , Pavon Anna Giulia , Aquaro Giovanni D , Barison Andrea , Todiere Giancarlo , Rabbat Mark G , Tat Emily , Raineri Claudia , Valentini Adele , Varga-Szemes Akos , Schoepf U. Joseph , De Cecco Carlo N , Bogaert Jan , Dobrovie Monica , Symons Rolf , Focardi Marta , Gismondi Annalaura , Lozano-Torres Jordi , Rodriguez-Palomares Josè F , Lanzillo Chiara , Di Roma Mauro , Moro Claudio , Di Giovine Gabriella , Margonato Davide , De Lazzari Manuel , Perazzolo Marra Martina , Nese Alberto , Casavecchia Grazia , Gravina Matteo , Marzo Francesca , Carigi Samuela , Pica Silvia , Lombardi Massimo , Censi Stefano , Squeri Angelo , Palumbo Alessandro , Gaibazzi Nicola , Camastra Giovanni , Sbarbati Stefano , Pedrotti Patrizia , Masi Ambra , Carrabba Nazario , Pradella Silvia , Timpani Mauro , Cicala Gloria , Presicci Cristina , Puglisi Sara , Sverzellati Nicola , Santobuono Vincenzo Ezio , Pepi Mauro , Schwitter Juerg , Pontone Gianluca 
Published: December 2020

Abstract

Aims
The aim of this registry was to evaluate the additional prognostic value of a composite cardiac magnetic resonance (CMR)-based risk score over standard-of-care (SOC) evaluation in a large cohort of consecutive unselected non-ischaemic cardiomyopathy (NICM) patients.

Methods and results
In the DERIVATE registry (www.clinicaltrials.gov/registration: RCT#NCT03352648), 1000 (derivation cohort) and 508 (validation cohort) NICM patients with chronic heart failure (HF) and left ventricular ejection fraction &lt;50% were included. All-cause mortality and major adverse arrhythmic cardiac events (MAACE) were the primary and secondary endpoints, respectively. During a median follow-up of 959 days, all-cause mortality and MAACE occurred in 72 (7%) and 93 (9%) patients, respectively. Age and &gt;3 segments with midwall fibrosis on late gadolinium enhancement (LGE) were the only independent predictors of all-cause mortality (HR: 1.036, 95% CI: 1.0117–1.056, P &lt; 0.001 and HR: 2.077, 95% CI: 1.211–3.562, P = 0.008, respectively). For MAACE, the independent predictors were male gender, left ventricular end-diastolic volume index by CMR (CMR-LVEDVi), and &gt;3 segments with midwall fibrosis on LGE (HR: 2.131, 95% CI: 1.231–3.690, P = 0.007; HR: 3.161, 95% CI: 1.750–5.709, P &lt; 0.001; and HR: 1.693, 95% CI: 1.084–2.644, P = 0.021, respectively). A composite clinical and CMR-based risk score provided a net reclassification improvement of 63.7% (P &lt; 0.001) for MAACE occurrence when added to the model based on SOC evaluation. These findings were confirmed in the validation cohort.

Conclusion
In a large multicentre, multivendor cohort registry reflecting daily clinical practice in NICM work-up, a composite clinical and CMR-based risk score provides incremental prognostic value beyond SOC evaluation, which may have impact on the indication of implantable cardioverter-defibrillator implantation.