Key result
DERIVATE 2.0 improves arrhythmic risk reclassification ~55% over version 1.0.
Why the study?
Does the DERIVATE Risk Score 2.0 improve the prediction of major adverse arrhythmic cardiac events compared to the DERIVATE Risk Score 1.0 and LVEF cut-off of 35% in patients with non-ischaemic cardiomyopathy?
Cohort (n=1,384)
Does the DERIVATE Risk Score 2.0 improve the prediction of major adverse arrhythmic cardiac events compared to the DERIVATE Risk Score 1.0 and LVEF cut-off of 35% in patients with non-ischaemic cardiomyopathy?
A new CMR-based risk score incorporating the presence and location of midwall late gadolinium enhancement significantly improves arrhythmic risk stratification in non-ischaemic cardiomyopathy compared to LVEF alone.
Aims Selection of the patients for implantable cardioverter defibrillator primary prevention therapy in non-ischaemic cardiomyopathy (NICM) needs to be improved. To evaluate the additional prognostic value of a new cardiac magnetic resonance (CMR) score based on late gadolinium enhancement (LGE) pattern distribution (DERIVATE Risk Score 2.0) when compared with previously published DERIVATE Risk Score 1.0, which is based solely on quantitative parameters, in a cohort of NICM patients enrolled in the DERIVATE registry. Methods and results One thousand three hundred and eighty-four NICM patients with chronic heart failure and left ventricular ejection fraction (LVEF) < 50% were evaluated for primary sudden cardiac death prevention therapy. Major adverse arrhythmic cardiac events (MAACEs) were the primary endpoint. During a median follow-up of 959 days, MAACE occurred in 128 (9.2%) patients. In the multivariate analyses, male gender [hazard ratio (HR): 1.605 (95% confidence interval, CI: 1.051–2.451); P = 0.028], LVEF per point % [HR: 0.977 (95% CI: 0.961–0.993); P = 0.005] and presence and location of midwall LGE [weighted HR: 1.066 (95% CI: 1.045–1.086), P < 0.001] were independent predictors of MAACE. A multi-parametric CMR-weighted predictive-derived score (DERIVATE Risk Score 2.0) provided a higher additional prognostic value vs. transthoracic echocardiography–LVEF cut-off of 35% when compared with the previous published DERIVATE Risk Score 1.0 with a net reclassification improvement of 54.52% (95% CI: 36.52–72.52%; P < 0.001). These findings were confirmed in the validation cohort. Conclusion The presence of midwall LGE, but also the location of scar, confers an added and independent MAACE risk to a large NICM population influencing the choice of treatment.
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Guaricci et al. (2025) conducted a cohort in Non-ischaemic cardiomyopathy (n=1,384). DERIVATE Risk Score 2.0 vs. DERIVATE Risk Score 1.0 and LVEF cut-off of 35% was evaluated on Major adverse arrhythmic cardiac events (MAACEs) (NRI 54.52%, 95% CI 36.52-72.52, p=<0.001). The DERIVATE Risk Score 2.0 significantly improved risk reclassification for major adverse arrhythmic cardiac events compared to the DERIVATE Risk Score 1.0 (NRI 54.52%; 95% CI 36.52-72.52; P<0.001).
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