High-risk arrhythmic genotypes in DCM patients increased advanced heart failure events (HR 4.01) and major ventricular arrhythmias (HR 3.41) compared to other genotypes.
Does the presence of high-risk arrhythmic genotypes increase the risk of advanced heart failure events in patients with dilated cardiomyopathy?
Patients with dilated cardiomyopathy and high-risk arrhythmic genotypes have a significantly higher risk of developing advanced heart failure complications, suggesting a need for tailored therapeutic strategies beyond sudden death prevention.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Certain genetic forms of dilated cardiomyopathy (DCM) entail a higher arrhythmic risk. It is unknown whether DCM patients with high-risk arrhythmic genotypes also develop more advanced heart failure (AHF) complications. Purpose We studied the incidence of AHF events according to DCM genotype with a special focus on individuals with variants in high-risk arrhythmic genes. Methods Clinical data from 1,203 genotyped DCM patients (51.4 years, 67.3% males, 33 25-42 % LVEF) were collected from 19 Spanish centers. Patients were classified in high-risk arrhythmic genotypes (LMNA, FLNC, desmosomal genes, PLN, TMEM43, RBM20), TTN, other genes, and genotype negative (Gen-). The primary endpoint was a composite of AHF events (ventricular assist device implantation, heart transplant, and AHF-related mortality). Secondary endpoint was a combination of major ventricular arrhythmic events (MVA). Results A DCM-causing variant was identified in a high-risk arrhythmic gene in 185 patients (15.4%), 193 (16.0%) had variants in TTN, 134 (11.1%) in other genes and 691 (57.4%) were Gen-. After a median follow-up of 5.7 years (IQR: 2.9-9.1), AHF events occurred in 45 (24.3%) patients in the high-risk arrhythmic group, while in 25 (18.7%), 25 (13.0%) and 70 (10.1%) patients with other genotypes, TTN and Gen-, respectively (HR: 1.85, 95%CI: 1.31-2.61 for high-risk arrhythmic genes compared with other groups). MVA occurred in 55 patients (29.7%) (HR: 2.52, 95%CI: 1.81-3.51 for high-risk genotypes vs. other groups). In a multivariate analysis (adjusted for genotype, LGE, LVEF and NYHA class), a high-risk arrhythmic genotype was the main independent predictor of AHF (HR 4.01, 95%CI: 1.73-9.34). A high-risk arrhythmic genotype (HR 3.41, 95%CI: 1.87-6.21, p0.001) and LGE (HR 3.57, 95%CI: 2.15-5.91, p0.001) were independent predictors of MVA, while LVEF and NYHA functional class were not. Conclusions Patients with high-risk arrhythmic genotypes also experience more advanced heart failure events, supporting a differential therapeutic approach in this group of patients beyond sudden death prevention.AHF and MVA according to genotype Outcomes and Events during follow-up
Ayestaran et al. (Sat,) informaron un otro. Los genotipos arrítmicos de alto riesgo en pacientes con DCM aumentaron los eventos de insuficiencia cardíaca avanzada (HR 4.01) y las arritmias ventriculares mayores (HR 3.41) en comparación con otros genotipos.