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B-PO01-079 INCREMENTAL PROGNOSTIC VALUE OF MYOCARDIAL DEFORMATION IN PATIENTS WITH NON-ISCHEMIC DILATED CARDIOMYOPATHY: A FEATURE-TRACKING CARDIAC MAGNETIC RESONANCE STUDY

      Background

      Myocardial deformation imaging using cardiac magnetic resonance feature-tracking (CMR-FT) has demonstrated to provide prognostic information in patients with non-ischemic dilated cardiomyopathy (NIDCM). However, little is known about its value in predicting life-threatening ventricular arrhythmic events and refining the selection of candidates to primary prevention implantable cardioverter-defibrillator implantation (ICD).

      Objective

      we sought to assess the long-term prognostic value of CMR-FT derived global longitudinal strain (GLS) and mechanical dispersion (MD) in risk stratification of sudden cardiac death (SCD) and VA in a large cohort of NIDCM patients.

      Methods

      We enrolled 399 NIDCM patients who underwent contrast-enhanced CMR. The endpoint of the study was time to the composite outcome of SCD, resuscitated cardiac arrest due to ventricular fibrillation or hemodynamically unstable ventricular tachycardia and appropriate ICD therapy.

      Results

      After a median follow-up of 51 (34-70) months, 40 (10%) patients reached the composite outcome. After multivariable adjustment, presence of late gadolinium enhancement (LGE: HR 1.43, 95% CI 1.06-7.39, p=0.02), GLS (HR 1.14, 95% CI 1.01-1.30, p=0.02) and MD (HR 1.16, 95% CI 1.08-1.43, p<0.001) were independently associated with the outcome event. The addition of GLS and MD to a risk model based on LVEF and LGE alone resulted in a significant improvement of the discriminatory power (C-statistics 0.83 to 0.89; p=0.003 and 0.83 to 0.93; p<0.001) with a continuous net reclassification improvement (NRI) of 0.78 and 1.49, respectively. The discriminatory power of the model based on MD was higher compared to the model containing GLS (p=0.02), having a continuous NRI of 1.41.

      Conclusion

      In NIDCM patients, CMR-FT derived GLS and MD are independent predictors of malignant VA, incremental to LVEF and LGE. In particular, MD seems to be more accurate in arrhythmic risk-stratification.