Non-dilated left ventricular cardiomyopathy was found in 7.4% of OHCA survivors, representing 40% of cardiomyopathies and often presenting as the first cardiac event.
NDLVC accounts for 40% of cardiomyopathies in OHCA survivors, highlighting it as a significant and newly recognized cause of malignant arrhythmias.
Abstract Background Non-dilated left ventricular cardiomyopathy (NDLVC) is a newly recognized form of cardiomyopathy, characterized by the presence of left ventricular (LV) dysfunction without dilatation, with or without scarring on cardiac magnetic resonance (CMR), or by the presence of non-ischemic scar tissue without LV dysfunction. No previous studies analysed NDLVC patients’ presenting with out-of-hospital cardiac arrest (OHCA) and the prevalence of this cardiomyopathy remains unknown. Purpose This multicentre study aims to evaluate the prevalence of NDLVC in patients presenting with OHCA and to characterize the various features of this specific form of cardiomyopathy. Method All survivors of tachyarrhythmic OHCA in Rimini and Trieste from 2017 to 2024 were evaluated, with a focused analysis on NDLVC. Patients with NDLVC were divided into three groups: Group 1: Non-ischemic scar and/or fatty replacement (LGE+ on CMR) with normal systolic function (LVEF 50%). Group 2: Non-ischemic scar and/or fatty replacement (LGE+ on CMR) with reduced systolic function (LVEF ≤50%).Group 3: No scar or fatty replacement with reduced systolic function (LVEF 50%). Results Among 472 OHCA, 256 patients survived and 47 of them (18%) had cardiomyopathies. 19 patients met the diagnostic criteria for NDLVC, representing 40% of cardiomyopathies, 7.4% of OHCA survivors and 4% of total OHCA cases over the eight-year period. NDLVC cohort was predominantly male (79%), with a mean age of 51 ± 18 years, in 15 cases (79% of the study population) OHCA was the first manifestation of cardiomyopathy. Group 1, consisting of 8 patients (42% of the NDLVC population), included forms of cardiomyopathy previously described as arrhythmogenic cardiomyopathy with LV involvement. The mean LVEF on CMR was 57%. Subepicardial LGE was present in 7 patients (88%), with LV free-wall involvement in 6 cases (75%). Group 2 included 6 subjects (31% of the NDLVC population) and mean LVEF on CMR was 46%. Subepicardial LGE was observed in 5 patients (84%), with LV free-wall involvement in 3 cases (50%). Group 3 was composed of 5 individuals (26% of the NDLVC population), mean LVEF on echocardiography was 44%, CMR was performed in 2 individuals (40%) and none showed LGE. Conclusions NDLVC represents a significant proportion of cardiomyopathies associated with OHCA. Red flags for the onset of malignant arrhythmias include male sex, young age, a family history of sudden cardiac death (SCD), subepicardial LGE involving the LV free wall, inverted T waves, QRS fragmentation, low QRS voltage and specific genetic mutations. These preliminary findings pave the way for future research regarding risk stratification of NDLVC patients and family members.NDLVC subtypes NDLVC
Domenico et al. (2025) studied this question. Non-dilated left ventricular cardiomyopathy was found in 7.4% of OHCA survivors, representing 40% of cardiomyopathies and often presenting as the first cardiac event.