Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02302-4
Regional Cardiac Denervation Predicts Sustained Ventricular Arrhythmias in Non-Ischemic Cardiomyopathy Patients Without LGE on CMR imaging
C. Jungen1, S. Chen2, A. P. Wijnmaalen2, P. Dibbets-Schneider3, S. Piers2, Y. Kimura2, A. Androulakis2, R. van der Geest3, L.-F. Geus-Oei3, A. Scholte2, H. Lamb3, M. Jongbloed2, K. Zeppenfeld2
1Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen; 2Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, NL; 3Department of Radiology, Leiden University Medical Center, Leiden, NL;

Background:
In patients with non-ischemic cardiomyopathy (NICM) and no late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR), risk prediction for the occurrence of sustained ventricular arrhythmias (VA) is challenging. Global and regional sympathetic denervation has been associated with VA in patients with ischemic cardiomyopathy, but its influence in NICM patients is unknown.

 

Purpose:
To assess the association and prognostic relevance for regional sympathetic denervation with the occurrence of VA in NICM patients.

 

Methods:
Consecutive patients from the ‘Leiden Nonischemic Cardiomyopathy Study’, who underwent programmed electrical stimulation, LGE-CMR and 123I- MIBG imaging between 2011-2018 were included. The presence of LGE and global and regional sympathetic denervation on 123I- MIBG was evaluated and patients were followed for occurrence of VA. Global denervation was assessed using the heart-to-mediastinum ratio and regional denervation was evaluated by calculating the number of denervated segments, the ratio of denervated segments, the summed defect score and the weighted denervation size.

 

Results: 
Of 75 included patients (63 years [52-68], 79% male, LVEF 36% [27-44], 37% inducible for VA) 35 had no LGE. During 4.5±1.6 years follow-up, VA occurred in 8/35 (23%) patients without LGE and in 18/40 (45%) patients with LGE. Among patients without LGE, those with VA had greater regional sympathetic denervation (number of denervated segments 8 [8-10] vs. 2 [1-5], P=0.004; ratio of denervated segments 0.5 [0.5-0.7] vs. 0.2 [0.1-0.4], P=0.007; summed defect score 36 [31-41] vs. 18 [14-24], P=0.01; weighted denervation size 47 [39-53] vs. 22 [16-30], P=0.01). In patients without LGE, denervation ≥ 7 segments identified patients at risk for VA (AUC: 0.83, sensitivity: 88%; specificity: 89%).

In univariable analysis the number of denervated segments (HR 1.25, 95% CI 1.06–1.46, P=0.006) was associated with the occurrence of VA in patients without LGE. Among patients with LGE there were no differences in CMR or MIBG parameters in those with and without VA.

Conclusions:
In NICM patients without LGE the extent of regional denervation may contribute to risk stratification for VA.

 
 
 
 

 

 

 
https://dgk.org/kongress_programme/ht2023/aV534.html