Key result
Reduced left ventricular ejection fraction (<55.0%) was associated with an elevated risk of major adverse cardiac events compared to preserved LVEF (aHR 7.21; 95% CI 1.99-26.1).
Why the study?
Muscular dystrophy patients face elevated risk of serious cardiac complications but clinical assessment is limited by physical limitations, prompting evaluation of TTE-derived LVEF as a prognostic marker for MACE.
Does LVEF derived from TTE prognosticate major adverse cardiac events in patients with muscular dystrophy?
Cohort (n=165)
Does LVEF derived from TTE prognosticate major adverse cardiac events in patients with muscular dystrophy?
Effect estimate: aHR 7.21 (95% CI 1.99-26.1)
LVEF assessed by TTE is a strong prognostic marker for MACE in patients with muscular dystrophy, and improvement in LVEF with medical/device therapy optimization is associated with better outcomes.
May flag high MACE risk via TTE LVEF in muscular dystrophy; leaves open whether optimization alters outcomes.
BACKGROUND: Patients with muscular dystrophy (MD) are at elevated risk of serious cardiac complications and clinical assessment is limited due to inherent physical limitations. We assessed the utility of left ventricular ejection fraction (LVEF) derived from transthoracic echocardiogram (TTE) as a prognostic marker for major adverse cardiac events (MACE) in a mixed adult MD cohort. METHODS: One hundred and sixty-five MD patients (median age: 36 (interquartile range [IQR]: 23.0-49.0) years; 65 [39.4%] females) were enrolled in our prospective cohort study. Diagnoses included dystrophinopathies (n = 42), limb-girdle MD (n = 31), type 1 myotonic dystrophy (n = 71), and facioscapulohumeral MD (n = 21). Left ventricular ejection fraction, ventricular dimensions at end-diastole and end-systole, and serial measures (n = 124; follow-up period: 2.19 [IQR: 1.05-3.32] years) stratified patients for MACE risk. RESULTS: Cardiomyopathy was diagnosed in 60 (36.4%) patients of the broader cohort (median LVEF: 45.0 [IQR: 35.0-50.0] %). Ninety-eight MACE occurred over the 7-year study period. At baseline, patients with a LVEF < 55.0% had a high risk of MACE (adjusted odds ratio: 8.30; 95% confidence interval [CI]: 3.18-21.7), concordant with the analysis of LV dimensions. Forty-one percent of these patients showed an improvement in LVEF with the optimization of medical and device therapies. Relative to patients with preserved LVEF, patients with reduced LVEF were at an elevated risk of MACE (adjusted hazard ratio [aHR]: 7.21; 95% CI: 1.99-26.1), and improved LVEF resulted in comparable outcomes (aHR: 1.84; 95% CI: .49-6.91) associated with optimization of medical and device therapies. Reduction in QRS duration by CRT therapy was associated with an improvement in LVEF (average improvement: 12.8 [± 2.30] %; p = .04). CONCLUSIONS: Reduction in LVEF indicates an increased risk of cardiovascular events in patients with MD. Baseline and serial LVEF obtained by TTE can prognosticate patients for MACE and guide clinical management.
No takes yet. Share an insight, caveat, or question.
Nikhanj et al. (2022) conducted a cohort in Muscular dystrophy (n=165). Reduced LVEF (<55.0%) vs. Preserved LVEF was evaluated on Major adverse cardiac events (MACE) (aHR 7.21, 95% CI 1.99-26.1). Reduced left ventricular ejection fraction (<55.0%) was associated with an elevated risk of major adverse cardiac events compared to preserved LVEF (aHR 7.21; 95% CI 1.99-26.1).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: