Key result
NSIVCD linked to ~72% greater risk of major cardiovascular events in dilated cardiomyopathy.
Why the study?
Although LBBB is independently associated with adverse outcomes in dilated cardiomyopathy, prognostic data on nonspecific intraventricular conduction delay remain limited and conflicting.
Does nonspecific intraventricular conduction delay predict adverse outcomes in patients with dilated cardiomyopathy?
Cohort (n=548)
No
Does nonspecific intraventricular conduction delay predict adverse outcomes in patients with dilated cardiomyopathy?
Hazard Ratio: 1.716 (95% CI 1.092–2.854)
Absolute Event Rate: 49.2% vs 14.7%
p-value: p=< 0.001
Nonspecific intraventricular conduction delay is an independent predictor of adverse outcomes in patients with dilated cardiomyopathy, similar to left bundle branch block.
May support conduction-based risk stratification in dilated cardiomyopathy; extends LBBB data but leaves open need for prospective validation.
PURPOSE: Left bundle branch block (LBBB) has been confirmed to be independently associated with adverse outcomes in dilated cardiomyopathy (DCM). However, prognostic data on nonspecific intraventricular conduction delay (NSIVCD) are still limited and conflicting. We aimed to evaluate the prognosis of DCM with NSIVCD. METHODS: A total of 548 DCM patients who underwent cardiovascular magnetic resonance imaging (CMR) from January 2016 to December 2017 were consecutively enrolled. The cohort was divided into four groups: 87 with LBBB, 27 with RBBB, 61 with NSIVCD, and 373 without intraventricular conduction delay (IVCD). After a median follow-up of 58 months (interquartile range: 47-65), 123 patients reached the composite endpoints, which included cardiovascular death, heart transplantation, and malignant arrhythmias. The associations between different patterns of IVCD and the outcomes of DCM were analysed by Kaplan‒Meier analysis and Cox proportional hazards regression analysis. RESULTS: Of 548 DCM patients, there were 398 males (72.6%), and the average age was 46 ± 15 years, ranging from 18 to 76 years. In Kaplan‒Meier analysis, patients with NSIVCD and LBBB showed higher event rates than patients without IVCD, while RBBB patients did not. By multivariate Cox regression analysis, LBBB, NSIVCD, NYHA class, left ventricular ejection fraction (LVEF), indexed left ventricular end-diastolic diameter (LVEDDI), percentage of late gadolinium enhancement mass (LGE%), and global longitudinal strain (GLS) were found to be independently associated with the outcomes of DCM. CONCLUSIONS: In addition to LBBB, NSIVCD was an unfavourable prognostic marker in patients with DCM, independent of LVEDDI, NYHA class, LVEF, LGE%, and GLS.
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Yuan et al. (2023) conducted a cohort in Dilated cardiomyopathy (n=548). Nonspecific intraventricular conduction delay vs. No intraventricular conduction delay was evaluated on Composite of sudden cardiac death, heart failure death, heart transplantation, LV assist device installation, malignant ventricular arrhythmias, and appropriate ICD/CRT-D shocks (HR 1.716, 95% CI 1.092-2.854, p=< 0.001). Nonspecific intraventricular conduction delay was independently associated with an increased risk of adverse composite cardiovascular outcomes (HR 1.716) in patients with dilated cardiomyopathy.
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