Late gadolinium enhancement and the risk of ventricular arrhythmias and sudden death in NYHA I patients with non‐ischemic cardiomyopathy

Aims
To compare the risk of ventricular arrhythmias (VA) and sudden death (SD) between NYHA I and NYHA II-III patients with non-ischemic cardiomyopathy (NICM).
Methods and results
Observational retrospective cohort study including patients with NICM who underwent cardiac magnetic resonance at two hospitals. The primary endpoint included appropriate ICD therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. The secondary endpoint included heart failure (HF) hospitalizations, heart transplant, left ventricular assist device implant or HF death.
698 patients were included, 33% in NYHA I. During a median follow-up of 31 months, the primary endpoint occurred in 57 patients (8%), with no differences between NYHA I and NYHA II-III cases (7% vs 9%, p=0.62). LGE was the only independent predictor of the primary outcome both in NYHA I and in NYHA II-III patients. LGE+ NYHA I patients had similar cumulative incidence of the primary endpoint as compared to LGE+ NYHA II-III (p=0.92) and significantly higher risk as compared to LGE- NYHA II-III cases (pConclusions
Patients with NICM in NYHA I are not necessarily at low risk of VA and SD. Actually, LGE+ NYHA I patients have a high risk. NYHA I patients with high-risk factors, such as LGE, could benefit from primary prevention ICD at least as much as those in NYHA II-III with the same risk factors.