The extent of late gadolinium enhancement predicts mortality, sudden death and major adverse cardiovascular events in patients with nonischaemic cardiomyopathy: a systematic review and meta-analysis.

AIM: To conduct a systematic review and meta-analysis with the objective of evaluating the prognostic value of extent of myocardial fibrosis by late gadolinium-enhanced cardiac magnetic resonance imaging (CMR) in non-ischaemic dilated cardiomyopathy (NICM). MATERIAL AND METHODS: The databases PubMed, EMBASE, and Google Scholar were searched for studies that investigated the prognostic value of quantification of late gadolinium enhancement (LGE) in patients with NICM. Unadjusted and adjusted hazard ratios (HRs) of uniformly defined predictors were pooled for meta-analysis. RESULTS: Fourteen studies were retrieved from 884 publications for this systematic review and meta-analysis. In total, 4,336 patients (mean age 51.2 years; mean follow-up 35.1 months) were included in the analysis. Meta-analysis showed the extent of LGE was associated with an increased risk of all-cause mortality (HR: 1.07/1% LGE; 95% confidence interval [CI]: 1.03-1.11; p=0.0003), composite arrhythmic endpoint (HR: 1.09/1% LGE; 95% CI: 1.03-1.15; p=0.002) and major adverse cardiovascular events (MACE; HR: 1.06/1% LGE; 95% CI: 1.02-1.11; p=0.005). After adjusting for baseline characteristics, the higher extent of LGE remained associated with the risk of all-cause mortality (HRadjusted: 1.07/1% LGE; 95% CI: 1.00-1.14; p=0.04), also strongly associated with the risk of composite arrhythmic endpoint (HRadjusted: 1.07; 95% CI: 1.02-1.012; p=0.004) and MACE (HRadjusted: 1.04; 95% CI: 1.01-1.08; p=0.005). CONCLUSIONS: Extent of LGE in CMR predicts all-cause mortality, arrhythmic events, and MACE. Collectively, these findings emphasise that extent of LGE by CMR may have value for optimising current predictive models for clinical events or mortality in patients with NICM.

Prognostic value of myocardial strain by magnetic resonance imaging in nonischemic dilated cardiomyopathy: a systematic review and meta-analysis.

Aim    This study was aimed at performing a systematic review and meta-analysis to investigate the prognostic role of left ventricular (LV) myocardial strain variables as determined by magnetic-resonance imaging in non-ischemic dilated cardiomyopathy.Material and methods    A search was performed in PubMed (MEDLINE), Google Scholar, and EMBASE databases for studies on the prognostic role of LV myocardial strain based on MR feature-tracking in non-ischemic dilated cardiomyopathy. Uncorrected odds ratio (OR) values reported by the studies where similar evaluation criteria of myocardial strain were available, were combined for a meta-analysis.Results    Nine studies were selected from 351 publications for this systematic review and meta-analysis. The analysis included a totality of 2139 patients (mean age, 52.3 years; mean follow-up duration, 42.5 months). The meta-analysis showed that the worsening of the LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) was associated with increased risk of major adverse cardiovascular events (MACE): OR, 1.13  per each % of GLS; 95 % CI: 1.050-1.225; p=0.001; OR, 1.16 per each % of GCS; 95 % CI: 1.107-1.213; p<0.0001; OR, 0.95 per each % of GRS; 95 % CI: 0.92-0.97; p<0.0001.Conclusion    The LV GLS, GCS, and GRS variables by MR feature-tracking data are powerful predictors for the development of MACE. Evaluation of myocardial strain can be used as an effective instrument for risk stratification in patients with non-ischemic dilated cardiomyopathy.

[Epicardial Fat and Atrial Fibrillation: the Role of Profibrinogenic Mediators].

BACKGROUND: Epicardial adipose tissue (EAT) has certain paracrine functions, which could be associated with proinflammatory and fibrotic changes in myocardium even in patients without structural heart disease but with atrial fibrillation (AF). PURPOSE: to evaluate interrelationship between clinical data, parameters of tissue Doppler imaging (TDI), EAT thickness estimated by magnetic resonance imaging (MRI), and biochemical markers of fibrosis and inflammation in patients with nonvalvular AF without concomitant ischemic heart disease (IHD). MATERIALS AND METHODS: We included in this study 39 AF patients without valvular pathology or IHD with normal or moderately increased left atrial (LA) dimension (mean age 50.8±13.9 years, 49 % men). The following groups were distinguished for analysis: with idiopathic AF (iAFgroup, n=21); with AF and arterial hypertension (AF+AH group, n=18); with normal (.

[Sudden Cardiac Death in Patients With Ischemic Heart Disease: From Mechanisms to Clinical Practice].

Ischemic heart disease (IHD) and acute coronary syndrome are the main cause of sudden cardiac death (SCD). Incidence of SCD in patients after myocardial infarction (MI) is 4-6-fold higher than in general population. The review focuses on electrophysiological changes during acute myocardial ischemia and mechanisms of myocardial electromechanical remodeling in remote period after MI. Current data on arrhythmia substrates and triggers are presented. Nowadays, the main guide for implantable cardioverter-defibrillator (ICD) use for primary prevention of SCD is reduced left ventricular ejection fraction. The significance of this parameter has been repeatedly demonstrated in large randomized studies. However, the use of a single indicator cannot solve the problem. In this review we present analysis of modern additional predictors of fatal arrhythmias which are available in clinical practice, as well as the perspective for further research of this highly important scientific, clinical, and social problem.

[Noninvasive Electrophysiological Predictors and Biomarkers of Malignant Arrhythmias in Patients With Ischemic Heart Disease: a 2-Year Prospective Follow-up].

AIM: to assess prognostic value of clinical and instrumental parameters, results of noninvasive electrophysiological tests and biomarkers as predictors of malignant ventricular arrhythmias in patients with ischemic heart disease (IHD) during long-term follow-up as well as during myocardial revascularization surgery and early postoperative period. MATERIAL: We prospectively enrolled 97 patients (mean age 61 ± 10 years) with angiographically confirmed coronary artery disease. Most patients (68%) had heart failure NYHA functional class II-III. Mean left ventricular ejection fraction (LVEF) was 50 ± 13%; 20% of patients had LVEF ≤ 35%. Sixty two patients had revascularization procedures during follow-up. METHODS: We used 24-hour Holter monitoring and signal-averaged electrocardiography to obtain the following parameters: microvolt T-wave alternans, QT-interval duration and dynamics, heart rate turbulence (HRT) and variability. Laboratory tests included serum creatinine and creatinine clearance, brain natriuretic peptide (BNP), NT-proBNP, C-reactive protein and troponin T levels. RESULTS. During mean follow-up period of 25 ± 11 months life-threatening ventricular arrhythmias were observed in 11 patients (11%). On univariate analysis, history of percutaneous coronary intervention (p < 0.05), history of malignant arrhythmias or syncope (p < 0.05), LVEF ≤ 47% (p < 0.01), left atrium size 24.7 cm (p < 0.05), left atrium index (p = 0.01), filtered QRS duration (p < 0.05), abnormal heart rate turbulence (HRT) (chi-square test = 6.2, p = 0.01), abnormal turbulence slope (chi-square test = 9.5, p < 0.01), BNP ≥ 158 picogram/ml (p < 0.01), NT-proBNP ≥ 787 rg/ml (chi-square test = 4.4, p < 0.05) were significantly associated with malignant arrhythmias in long-term follow-up. History of malignant arrhythmias or syncope (OR 11.1, 95% Cl 2.8-44.4; p < 0.01), abnormal HRT (OR 13.6, 95% Cl 2.8-66.1; p < 0.01), and plasma BNP ≥ 158 picogram/ml (OR 14.3, 95% CI 3.2-65.0; p < 0.01) were independent predictors of malignant arrhythmias on multivariate Cox regression analysis. CONCLUSION: History of malignant arrhythmias, pathological HRT and plasma brain natriuretic peptide level ≥ 158 picogram/ml were independent predictors of malignant ventricular arrhythmias during 2 years follow-up of patients with IHD.

[Noninvasive Electrophysiological Predictors and Biomarkers of Malignant Arrhythmias in Patients With Ischemic Heart Disease: a 2-Year Prospective Follow-Up].

AIM: to assess prognostic value of clinical and instrumental parameters, results of noninvasive electrophysiological tests and biomarkers as predictors of malignant ventricular arrhythmias in patients with ischemic heart disease (IHD) during long-term follow-up as well as during myocardial revascularization surgery and early postoperative period. MATERIAL: We prospectively enrolled 97 patients (mean age 61+/-10years) with angiographically confirmed coronary artery disease. Most patients (68%) had heart failure NYHA functional class II-III. Mean left ventricular ejection fraction (LVEF) was 50+/-13%; 20% of patients had LVEF less or equal 35%. Sixty two patients had revascularization procedures during follow-up. METHODS: We used 24-hour Holter monitoring and signal-averaged electrocardiography to obtain the following parameters: microvolt T-wave alternans, QT-interval duration and dynamics, heart rate turbulence (HRT) and variability. Laboratory tests included serum creatinine and creatinine clearance, brain natriuretic peptide (BNP), NT-proBNP, C-reactive protein and troponin T levels. RESULTS: During mean follow-up period of 25+/-11 months life-threatening ventricular arrhythmias were observed in 11 patients (11%). On univariate analysis, history of percutaneous coronary intervention (p<0.05), history of malignant arrhythmias or syncope (p<0.05), LVEF less or equal 47% (p<0.01), left atrium size more or equal 4.7cm (p<0.05), left atrium index (p=0.01), filtered QRS duration (p<0.05), abnormal heart rate turbulence (HRT) (chi-square test=6.2, p=0.01), abnormal turbulence slope (chi-square test=9.5, p<0.01), BNP more or equal 158picogram/ml (p<0.01), NT-proBNP more or equal 787 rg/ml (chi-square test=4.4, p<0.05) were significantly associated with malignant arrhythmias in long-term follow-up. History of malignant arrhythmias or syncope (OR 11.1, 95% CI 2.8-44.4; p<0.01), abnormal HRT (R 13.6, 95% CI 2.8-66.1; p<0.01), and plasma BNP more or equal 158 picogram/ml (R 14.3, 95% CI 3.2-65.0; p<0.01) were independent predictors of malignant arrhythmias on multivariate Cox regression analysis. CONCLUSION: History of malignant arrhythmias, pathological HRT and plasma brain natriuretic peptide level more or equal 158 picogram/ml were independent predictors of malignant ventricular arrhythmias during 2 years follow-up of patients with ID.