Risk factors of adverse cardiovascular events in patients with isolated non-compaction cardiomyopathy

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OBJECTIVE

To identify the risk factors of adverse cardiovascular events in patients with isolated non-compaction cardiomyopathy (NCCM).

MATERIAL AND METHODS

There were 90 patients with isolated NCCM aged 25 — 47 years (median 34 years; 47 men and 43 women) and symptoms of chronic heart failure (CHF) NYHA class I—II. In addition to conventional examination, all patients underwent contrast-enhanced cardiac magnetic resonance. The endpoints of the study included progression of CHF up to NYHA class III requiring in-hospital treatment, ventricular tachyarrhythmias and embolic events.

RESULTS

CHF symptoms progressed up to NYHA class III in 22 out of 90 (24.4%) patients with isolated NCCM throughout the follow-up period from 6 to 90 months (median 25 months). Univariate analysis showed that the following variables were independent risk factors of CHF progression: baseline symptoms of CHF NYHA class II (HR 2.2; 95% CI 10.3—4.8, p 0.04), reduced LV EF ≤50% according to CMR (HR 9.1; 95% CI 3.2—26.0, p<0.001), LV ESD ≥44 mm according to TTE (HR 1.1; 95% CI 1.03—1.17, p<0.003). Fourteen (15.6%) patients developed ventricular tachyarrhythmias. Their risk factors were VPB >500 beats/min on 24-hour ECG monitor (HR 5.8; 95% CI 1.9—17.6, p=0.002) and GLS ≤11% (HR 0.79; 95% CI 0.66—0.96, p<0.018). Seven (7.8%) patients developed embolic events. Their predictors were baseline symptoms of CHF class II (HR 12.7; 95% CI 1.6—10.2, p=0.017); left bundle branch block (LBBB) (HR 3.7; 95% CI 0.95—14.5, p=0.058) and myocardial fibrosis according to CMR (HR 5.8; 95% CI 2—29, p=0.032). The 2-year event-free survival rate was 56.8% (95% CI; 46.7—69.2).

CONCLUSION

Risk factors of adverse events are baseline symptoms of CHF NYHA class II, LV EF ≤50%, LV ESD ≥44 mm, GLS ≤11%, and myocardial fibrosis according to CMR, LBBB and VPB >500 beats /min according to 24-hour ECG monitoring. These parameters can be used to identify high-risk patients.

Keywords:

isolated non-compaction cardiomyopathy

progressive heart failure

ventricular tachyarrhythmias

thromboembolic events

risk factors of events

Authors:

Komissarova S.M.

Republican Scientific and Practical Centre «Cardiology»

Krasko O.V.

United Institute of Informatics Problems of the National Academy of Sciences of Belarus

Rineiskaya N.M.

Republican Scientific and Practical Centre «Cardiology»

Sevruk T.V.

Republican Scientific and Practical Centre «Cardiology»

Ustinova I.B.

Republican Scientific and Practical Centre «Cardiology»

Received:

14.01.2022

Accepted:

27.01.2022

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