Key result
DERIVATE Risk Score 2.0 using midwall LGE improves MAACE prediction ~55% vs LVEF ≤35% in NICM.
Why the study?
ICD therapy prevents sudden cardiac death in non-ischemic dilated cardiomyopathy, but patient selection for primary prevention needs improvement.
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-ischemic cardiomyopathy?
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-ischemic cardiomyopathy?
A new CMR-based risk score incorporating midwall LGE presence and location significantly improves risk stratification for major arrhythmic events in non-ischemic cardiomyopathy compared to LVEF alone.
May refine arrhythmic risk stratification in NICM beyond LVEF; supports validation of CMR scores but remains hypothesis-generating.
Background Treatment with an implantable cardioverter-defibrillator (ICD) has proven to be an effective prophylactic strategy for the prevention of sudden cardiac death (SCD) in patients with non-ischemic dilated cardiomyopathy (NICM). However, the selection of patients for ICD primary prevention therapy In NICM needs to be improved. Purpose This study sought 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) as compared to the 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 we enrolled 1384 NICM patients with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) <50% were evaluated for primary SCD prevention therapy. Major adverse arrhythmic cardiac events (MAACE) were the primary endpoint. Results During a median follow-up of 959 days, MAACE occurred in 128 (9.2%) patients. In the multivariate analyses, male gender (HR: 1.605 [95% 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 multiparametric CMR weighted predictive derived score (DERIVATE Risk Score 2.0) provided a higher additional prognostic value vs TTE-LVEF cut-off of 35% as compared to the previously published DERIVATE Risk Score 1.0 with a net reclassification improvement (NRI) of 54.52% (CI95%: 36.52%-72.52%; p<0.001) (Figure). These findings were confirmed in the validation cohort. Conclusions The presence of midwall LGE, along with the location of scar, confers an added and independent MAACE risk in a large NICM population, influencing the choice of treatment.
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Fusini et al. (2025) studied this question. In NICM patients, the DERIVATE Risk Score 2.0 using midwall LGE location improved MAACE risk prediction with 54.52% NRI versus LVEF ≤35%.
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