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Phenotype, outcomes and natural history of early‐stage non‐ischaemic cardiomyopathy

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posted on 2024-01-05, 11:25 authored by Daniel J Hammersley, Richard E Jones, Ruth Owen, Lukas Mach, Amrit S Lota, Zohya Khalique, Antonio De Marvao, Emmanuel Androulakis, Suzan Hatipoglu, Ankur Gulati, Rohin K Reddy, Won Young Yoon, Suprateeka Talukder, Riya Shah, Resham Baruah, Kaushik Guha, Antonis Pantazis, A John Baksi, John Gregson, John GF Cleland, Upasana Tayal, Dudley J Pennell, James S Ware, Brian P Halliday, Sanjay K Prasad

AimsTo characterize the phenotype, clinical outcomes and rate of disease progression in patients with early‐stage non‐ischaemic cardiomyopathy (early‐NICM).Methods and resultsWe conducted a prospective observational cohort study of patients with early‐NICM assessed by late gadolinium enhancement cardiovascular magnetic resonance (CMR). Cases were classified into the following subgroups: isolated left ventricular dilatation (early‐NICM H−/D+), non‐dilated left ventricular cardiomyopathy (early‐NICM H+/D−), or early dilated cardiomyopathy (early‐NICM H+/D+). Clinical follow‐up for major adverse cardiovascular events (MACE) included non‐fatal life‐threatening arrhythmia, unplanned cardiovascular hospitalization or cardiovascular death. A subset of patients (n = 119) underwent a second CMR to assess changes in cardiac structure and function. Of 254 patients with early‐NICM (median age 46 years [interquartile range 36–58], 94 [37%] women, median left ventricular ejection fraction [LVEF] 55% [52–59]), myocardial fibrosis was present in 65 (26%). There was no difference in the prevalence of fibrosis between subgroups (p = 0.90), however fibrosis mass was lowest in early‐NICM H−/D+, higher in early‐NICM H+/D− and highest in early‐NICM H+/D+ (p = 0.03). Over a median follow‐up of 7.9 (5.5–10.0) years, 28 patients (11%) experienced MACE. Non‐sustained ventricular tachycardia (hazard ratio [HR] 5.1, 95% confidence interval [CI] 2.36–11.00, p < 0.001), myocardial fibrosis (HR 3.77, 95% CI 1.73–8.20, p < 0.001) and diabetes mellitus (HR 5.12, 95% CI 1.73–15.18, p = 0.003) were associated with MACE in a multivariable model. Only 8% of patients progressed from early‐NICM to dilated cardiomyopathy with LVEF <50% over a median of 16 (11–34) months.ConclusionEarly‐NICM is not benign. Fibrosis develops early in the phenotypic course. In‐depth characterization enhances risk stratification and might aid clinical management.

History

Refereed

  • Yes

Volume

25

Issue number

11

Publication title

European Journal of Heart Failure

ISSN

1388-9842

Publisher

Wiley

Location

England

File version

  • Published version

Language

  • eng

Item sub-type

Journal Article

Media of output

Print-Electronic

Affiliated with

  • School of Medicine Outputs