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Objectives <p>To assess the left ventricular remodeling index (LVRI) for predicting ventricular tachyarrhythmia (VTA) in patients with dilated cardiomyopathy (DCM) with left ventricular ejection fraction (LVEF) &lt; 35%.</p> Materials and methods <p>In this retrospective single-center study, consecutive DCM patients with LVEF &lt; 35% (<i>n</i> = 271) who underwent cardiac magnetic resonance (CMR) imaging were followed up. The study endpoint was VTA, including sudden cardiac death and major ventricular arrhythmias. The CMR-derived LVRI was defined as the cubic root of the LV end-diastolic volume divided by the maximal LV wall thickness. Competing risk regression analysis and Kaplan–Meier analysis were used to evaluate the association of LVRI with VTA.</p> Results <p>Over 71-month median follow-up (interquartile range: 17–134 months), 35 (12.9%, mean age 46.7 years, 27 males) participants reached VTA events. The presence (62.9% vs. 60.2%, <i>p</i> = 0.761) and extent (6.9 ± 6.6 vs. 6.5 ± 8.3, <i>p</i> = 0.747) of late gadolinium enhancement (LGE) and LVEF (23.3 ± 6 vs. 21.9 ± 10.3, <i>p</i> = 0.197) were not significantly different between the patients with and without endpoint. Kaplan–Meier curve analysis showed that participants with LVRI ≥ 7.5 were more likely to experience VTA (<i>p</i> &lt; 0.0001). In the multiple competing risk analysis, LVRI ≥ 7.5 (HR, 2.496; 95% CI: 1.213–5.138; <i>p</i> = 0.013) was observed as an independent predictor of VTA after adjusting for age, sex and left bundle branch block.</p> Conclusions <p>For nonischemic DCM patients with LVEF &lt; 35%, LVRI ≥ 7.5 was associated with lethal VTA events and provided incremental value over conventional CMR parameters.</p> Critical relevance statement <p>The left ventricular remodeling index (LVRI) was independently associated with ventricular tachyarrhythmias in dilated cardiomyopathy patients with LVEF &lt; 35%, and warrants future multicenter validation to assess incremental value over established predictors for implantable cardioverter-defibrillator decision-making.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Left ventricular ejection fraction did not exhibit significant prognostic value for end-stage dilated cardiomyopathy patients.</p> </ItemContent> <ItemContent> <p>Cardiac MRI (CMR)-assessed left ventricular remodeling index (LVRI) ≥ 7.5 was an independent predictor of ventricular tachyarrhythmia.</p> </ItemContent> <ItemContent> <p>LVRI provided incremental prognostic value over conventional CMR parameters.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>

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Left ventricular remodeling index to predict ventricular tachyarrhythmia in dilated cardiomyopathy with ejection fraction < 35%

  • 期刊论文

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  • 发表日期：

    2025年8月29日

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  • Xi Jia,
  • Weipeng Yan,
  • Xuan Ma,
  • Zhixiang Dong,
  • Jiaxin Wang,
  • Shujuan Yang,
  • Kankan Zhao,
  • Zhuxin Wei,
  • Yun Tang,
  • Pengyu Zhou,
  • Xingrui Chen,
  • Yujie Liu,
  • Xiuyu Chen,
  • Shihua Zhao

摘要

Objectives

To assess the left ventricular remodeling index (LVRI) for predicting ventricular tachyarrhythmia (VTA) in patients with dilated cardiomyopathy (DCM) with left ventricular ejection fraction (LVEF) < 35%.

Materials and methods

In this retrospective single-center study, consecutive DCM patients with LVEF < 35% (n = 271) who underwent cardiac magnetic resonance (CMR) imaging were followed up. The study endpoint was VTA, including sudden cardiac death and major ventricular arrhythmias. The CMR-derived LVRI was defined as the cubic root of the LV end-diastolic volume divided by the maximal LV wall thickness. Competing risk regression analysis and Kaplan–Meier analysis were used to evaluate the association of LVRI with VTA.

Results

Over 71-month median follow-up (interquartile range: 17–134 months), 35 (12.9%, mean age 46.7 years, 27 males) participants reached VTA events. The presence (62.9% vs. 60.2%, p = 0.761) and extent (6.9 ± 6.6 vs. 6.5 ± 8.3, p = 0.747) of late gadolinium enhancement (LGE) and LVEF (23.3 ± 6 vs. 21.9 ± 10.3, p = 0.197) were not significantly different between the patients with and without endpoint. Kaplan–Meier curve analysis showed that participants with LVRI ≥ 7.5 were more likely to experience VTA (p < 0.0001). In the multiple competing risk analysis, LVRI ≥ 7.5 (HR, 2.496; 95% CI: 1.213–5.138; p = 0.013) was observed as an independent predictor of VTA after adjusting for age, sex and left bundle branch block.

Conclusions

For nonischemic DCM patients with LVEF < 35%, LVRI ≥ 7.5 was associated with lethal VTA events and provided incremental value over conventional CMR parameters.

Critical relevance statement

The left ventricular remodeling index (LVRI) was independently associated with ventricular tachyarrhythmias in dilated cardiomyopathy patients with LVEF < 35%, and warrants future multicenter validation to assess incremental value over established predictors for implantable cardioverter-defibrillator decision-making.

Key Points

Left ventricular ejection fraction did not exhibit significant prognostic value for end-stage dilated cardiomyopathy patients.

Cardiac MRI (CMR)-assessed left ventricular remodeling index (LVRI) ≥ 7.5 was an independent predictor of ventricular tachyarrhythmia.

LVRI provided incremental prognostic value over conventional CMR parameters.

Graphical Abstract