Key result
Pathogenic variants in NICM link to ~370% higher VT recurrence risk after ablation.
Why the study?
Cardiomyopathy gene variants in NICM cause distinct scar phenotypes on DE-CMR that may impact VT management, but their relationship with imaging findings and long-term VT ablation outcomes was unclear.
Does genotyping and scar phenotyping predict VT recurrence in patients with nonischemic cardiomyopathy undergoing VT ablation?
Cohort (n=43)
Does genotyping and scar phenotyping predict VT recurrence in patients with nonischemic cardiomyopathy undergoing VT ablation?
Effect estimate: HR 4.7 (95% CI 1.22-18.0)
p-value: p=0.02
In patients with nonischemic cardiomyopathy undergoing VT ablation, the presence of pathogenic genetic variants is associated with deeper intramural scars and a significantly higher risk of VT recurrence.
May support genotyping for VT recurrence risk stratification in NICM ablation; leaves open prospective validation before guiding therapy.
INTRODUCTION: Variants of cardiomyopathy genes in patients with nonischemic cardiomyopathy (NICM) generate various phenotypes of cardiac scar and delayed enhancement cardiac magnetic resonance (DE-CMR) imaging which may impact ventricular tachycardia (VT) management. METHODS: The objective was to compare the findings of cardiomyopathy genetic testing on DE-CMR imaging and long-term outcomes among patients with NICM undergoing VT ablation procedures. Image phenotyping and genotyping were performed in a consecutive series of patients referred for VT ablation and correlated to survival free of VT. Scar depth index (SDI) (% of scar at 0-3 mm, 3-5 mm and >5 mm projected on the closest endocardial surface) was determined. RESULTS: Forty-three patients were included (11 women, 55 ± 14 years, ejection fraction (EF) 45 ± 16%) and were followed for 3.4 ± 2.9 years. Pathogenic variants (PV) were identified in 16 patients (37%) in the following genes: LMNA (n = 5), TTN (n = 5), DSP (n = 2), AMLS1 (n = 1), MYBPC3 (n = 1), PLN (n = 1), and SCN5A (n = 1). A ring-like septal scar (RLSS) pattern was more often seen in patients with pathogenic variants (66% vs 15%, p = .001). RLSS was associated with deeper seated scars (SDI >5 mm 30.6 ± 22.6% vs 12.4 ± 16.2%, p = .005), and increased VT recurrence (HR 5.7 95% CI[1.8-18.4], p = .003). After adjustment for age, sex, EF, and total scar burden, the presence of a PV remained independently associated with worse outcomes (HR 4.7 95% CI[1.22-18.0], p = .02). CONCLUSIONS: Preprocedural genotyping and scar phenotyping is beneficial to identify patients with a favorable procedural outcome. Some PVs are associated with an intramural, deeper seated scar phenotype and have an increase of VT recurrence after ablation.
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Kovacs et al. (2023) conducted a cohort in Nonischemic cardiomyopathy (NICM) undergoing VT ablation (n=43). Presence of pathogenic variants vs. Absence of pathogenic variants was evaluated on Worse outcomes (VT recurrence) (HR 4.7, 95% CI 1.22-18.0, p=0.02). The presence of a pathogenic variant in patients with nonischemic cardiomyopathy undergoing VT ablation was independently associated with worse outcomes (HR 4.7; 95% CI 1.22-18.0; p=0.02).
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