Factors associated with the risk of heart failure progression in patients with non-compaction cardiomyopathy
Authors: Rineiska N , Komissarova S , Haidzel I 
Published: October 2021

Abstract

Purpose
To identify factors associated with the progression of chronic heart failure (CHF) to NYHA FC III, requiring hospitalization and to reveal high-risk pts.

Methods
The study included 156 pts with non-compaction cardiomyopathy (NCCM), who were prospectively observed in the RSPC “Cardiology”. The median follow-up was 36 months (6; 152). All pts underwent echocardiography (Echo), cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) and 24-hour Holter monitoring. The median age of the pts was 36 (26; 49) years, men predominated (57.4%). The diagnosis of NCCM was established on the basis of the following criteria: Echo – Jenni criteria, CMR – Petersen/Jaquier criteria. The end point of the study included progression of CHF from NYHA FC II to FC III, requiring hospitalization.

Results
At the initial examination, symptoms of CHF NYHA FC I were found in 56 (55.4%) pts, symptoms of CHF NYHA FC II – in 45 (44.6%) pts, systolic dysfunction was detected in 43% of pts. During the follow-up period, out of 156 pts, 55 (35.3%) had CHF symptoms that progressed to NYHA FC III and required hospitalization. As a result of the bivariate analysis, the following Echo characteristics were independent factors associated with a high risk of progression of CHF to NYHA FC III: LV EF &lt;40% (HR 6.2; 95% CI 3.4–11.2); end-diastolic LV diameter &gt;62 mm (HR 5.3; 95% CI 2.9–9.7); end-systolic LV diameter &gt;56 mm (HR 6.6; 95% CI 3.8–11.7); end-diastolic LV volume &gt;187 ml (HR 4.4; 95% CI 2.5–8); end-systolic LV volume &gt;93 ml (HR 6.5; 95% CI 3.2–13). The risk of progression of CHF to NYHA FC III was 3.4 times higher in pts with right ventricular (RV) systolic dysfunction: with a decrease of RV fractional area change (FAC) &lt;31% (HR 3.4; 95% CI 1.8–6.3) and 2.5 times higher with a decrease of tricuspid annular plane systolic excursion (TAPSE) (HR 2.5; 95% CI 1.3–4.5); 2.5 times higher in pts with initially increased anteroposterior RV diameter &gt;28 (HR 2.5; 95% CI 1,4–4.5).
According to the LGE-CMR data, the factors associated with the risk of progression of CHF to NYHA FC III were the following characteristics: an increase of BSA-indexed end-diastolic LV volume &gt;145 ml/m2 (HR 6.7; 95% CI 3.4–13.3); BSA-indexed end-systolic LV volume &gt;96 ml/m2 (HR 6.8; 95% CI 3.4–13.6); and an increase of RV end-systolic volume &gt;145 ml (HR 5.0; 95% CI 2.3–11). The risk of CHF progression was 4.8 times higher in pts with baseline LV systolic dysfunction (LV EF &lt;34%, HR 4.8; 95% CI 2.8–8.2); 2.7 times higher in pts with RV systolic dysfunction (LVEF &lt;42%, HR 2.7; 95% CI 1.6–4.8). The NC/C ratio and the presence of myocardial replacement fibrosis according to LGE-CMR did not significantly affect the risk of progression of CHF.

Conclusion
The factors identified as a result of the study associated with the risk of progression of CHF based on biventricular assessment by cardiac imaging methods (Echo and LGE-CMR) can be used to reveal high-risk pts.

Funding Acknowledgement
Type of funding sources: None.