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Patients with non-ischemic cardiomyopathy and mid-wall striae have similar arrhythmic outcomes as ischemic cardiomyopathy

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Abstract

Purpose: While implantable cardioverter-defibrillator (ICD) therapy provides clear benefit in patients with ischemic cardiomyopathy (ICM), this is less clear in patients with non-ischemic cardiomyopathy (NICM). Mid-wall striae (MWS) fibrosis is an established cardiovascular magnetic resonance (CMR) risk marker observed in patients with NICM. We evaluated whether patients with NICM and MWS have similar risk of arrhythmia-related cardiovascular events as patients with ICM. Methods: We studied a cohort of patients undergoing CMR. The presence of MWS was adjudicated by experienced physicians. The primary outcome was a composite of implantable cardioverter-defibrillator (ICD) implant, hospitalization for ventricular tachycardia, resuscitated cardiac arrest, or sudden cardiac death. Propensity-matched analysis was performed to compare outcomes for patients NICM with MWS and ICM. Results: A total of 1,732 patients were studied, 972 NICM (706 without MWS, 266 with MWS) and 760 ICM. NICM patients with MWS were more likely to experience the primary outcome versus those without MWS (unadjusted subdistribution hazard ratio (subHR) 2.26, 95% confidence interval [CI] 1.51–3.41) with no difference versus ICM patients (unadjusted subHR 1.32, 95% CI 0.93–1.86). Similar results were seen in a propensity-matched population (adjusted subHR 1.11, 95% CI 0.63–1.98, p = 0.711). Conclusion: Patients with NICM and MWS demonstrate significantly higher arrhythmic risk compared to NICM without MWS. After adjustment, the arrhythmia risk of patients with NICM and MWS was similar to patients with ICM. Accordingly, physicians could consider the presence of MWS when making clinical decisions regarding arrhythmia risk management in patients with NICM.

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Abbreviations

CI:

Confidence interval

CIROC:

Cardiovascular Imaging Registry of Calgary

CMR:

Cardiac magnetic resonance

HF:

Heart failure

ICD:

Implantable cardioverter-defibrillator

ICM:

Ischemic cardiomyopathy

LGE:

Late gadolinium enhancement

LV:

Left ventricle

MWS:

Mid-wall striae

NICM:

Non-ischemic cardiomyopathy

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Acknowledgements

None.

Funding

This study was funded, in part, by the Calgary Health Foundation.

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Author notes

  1. Brennan A. Ballantyne and Bert Vandenberk contributed equally.

Authors and Affiliations

  1. Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Brennan A. Ballantyne, Bert Vandenberk, Derek S. Chew, Andrew Howarth, Bobak Heydari, Nowell Fine, Jonathan Howlett, James A. White & Robert Miller

  2. Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Carmen Lydell & James A. White

  3. Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada

    Steven Dykstra, Dina Labib, Carmen Lydell, Andrew Howarth, Bobak Heydari, Nowell Fine & James A. White

  4. Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium

    Bert Vandenberk

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Contributions

All authors contributed to the study concept and design. BB, SD, DL, CL, AH, and JW participated in data collection. SD, DL, AH, CL, JW, and RM contributed to image analysis. BB, BV, SD, JW, and RM contributed to data analysis. BB and BV generated the initial manuscript. All authors provided critical analysis of the manuscript during revisions. Additionally, all authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Robert Miller.

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Competing interests

Dr. Miller receives consulting fees and research support from Pfizer. Dr White received research support from Siemens Healthineers, Circle Cardiovascular Inc., Pfizer and is a shareholder of Cohesic Inc. Dr Howarth is a shareholder of Cohesic Inc.

Disclosures

Dr. Miller receives consulting fees and research support from Pfizer. Dr White received research support from Siemens Healthineers, Circle Cardiovascular Inc., Pfizer and is a shareholder of Cohesic Inc. Dr Howarth is a shareholder of Cohesic Inc.

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James A. White and Robert Miller co-senior authors.

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Ballantyne, B.A., Vandenberk, B., Dykstra, S. et al. Patients with non-ischemic cardiomyopathy and mid-wall striae have similar arrhythmic outcomes as ischemic cardiomyopathy. Int J Cardiovasc Imaging 39, 2005–2014 (2023). https://doi.org/10.1007/s10554-023-02904-z

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