Amine Tazibet, Staniel Ortmans, Charlotte Potelle, Christelle Marquie, Cédric Klein, Laurence Guedon, Eric Verbrugge, Claude Kouakam, François Brigadeau, Didier Klug, Sandro Ninni
{"title":"扩张型心肌病对心脏再同步化治疗的反应导致室性心律失常的长期风险。","authors":"Amine Tazibet, Staniel Ortmans, Charlotte Potelle, Christelle Marquie, Cédric Klein, Laurence Guedon, Eric Verbrugge, Claude Kouakam, François Brigadeau, Didier Klug, Sandro Ninni","doi":"10.1016/j.acvd.2025.06.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Improvements in pharmacological treatments and cardiac resynchronization therapy (CRT) raise questions about the benefit of implantable cardioverter defibrillators (ICDs) in non-ischaemic dilated cardiomyopathy (NI-DCM). In this context, the long-term incidence of ventricular arrhythmia events (VAEs) by response to CRT remains under-reported.</p><p><strong>Aims: </strong>To assess the long-term risk of VAE by response to CRT in patients with NI-DCM.</p><p><strong>Methods: </strong>Patients who underwent CRT-defibrillator (CRT-D) implantation for primary prevention of NI-DCM (left ventricular ejection fraction [LVEF]≤35%, bundle branch block>130ms) from February 2002 to January 2020 were retrospectively included. CRT response was defined as an increase in LVEF≥10%, with LVEF≥35% at first transthoracic echocardiography (TTE) evaluation. VAE was defined as a sudden arrhythmic death, sustained ventricular arrhythmia or device-treated ventricular arrhythmia, occurring after the first TTE evaluation.</p><p><strong>Results: </strong>A total of 192 patients (mean age 61years, 68% female, mean LVEF 25%) were included and followed for a median of 91months. Median time to first TTE evaluation after CRT-D implantation was 14months. The overall incidence of VAE was 18.8% (annual rate of 2.9%). CRT response was associated with a reduced risk of VAE (hazard ratio [HR]: 0.27, 95% CI: 0.14-0.55; P<0.001). Super responders to CRT had a lower risk of VAE compared to partial responders (HR: 0.06, 95% CI: 0.02-0.17; P<0.001). Among responders who were VAE free before generator replacement, super responders exhibited a lower incidence of VAE compared to partial responders (HR: 0.13, 95% CI: 0.02-0.82; P=0.04) after generator replacement.</p><p><strong>Conclusion: </strong>In patients with NI-DCM undergoing CRT-D implantation for primary prevention, the CRT response was associated with a 73% decrease in the risk of VAE. Partial responders present a higher rate of VAE compared to super responders, persisting after generator replacement.</p>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-term risk of ventricular arrhythmia in dilated cardiomyopathy by response to cardiac resynchronization therapy.\",\"authors\":\"Amine Tazibet, Staniel Ortmans, Charlotte Potelle, Christelle Marquie, Cédric Klein, Laurence Guedon, Eric Verbrugge, Claude Kouakam, François Brigadeau, Didier Klug, Sandro Ninni\",\"doi\":\"10.1016/j.acvd.2025.06.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Improvements in pharmacological treatments and cardiac resynchronization therapy (CRT) raise questions about the benefit of implantable cardioverter defibrillators (ICDs) in non-ischaemic dilated cardiomyopathy (NI-DCM). In this context, the long-term incidence of ventricular arrhythmia events (VAEs) by response to CRT remains under-reported.</p><p><strong>Aims: </strong>To assess the long-term risk of VAE by response to CRT in patients with NI-DCM.</p><p><strong>Methods: </strong>Patients who underwent CRT-defibrillator (CRT-D) implantation for primary prevention of NI-DCM (left ventricular ejection fraction [LVEF]≤35%, bundle branch block>130ms) from February 2002 to January 2020 were retrospectively included. CRT response was defined as an increase in LVEF≥10%, with LVEF≥35% at first transthoracic echocardiography (TTE) evaluation. VAE was defined as a sudden arrhythmic death, sustained ventricular arrhythmia or device-treated ventricular arrhythmia, occurring after the first TTE evaluation.</p><p><strong>Results: </strong>A total of 192 patients (mean age 61years, 68% female, mean LVEF 25%) were included and followed for a median of 91months. Median time to first TTE evaluation after CRT-D implantation was 14months. The overall incidence of VAE was 18.8% (annual rate of 2.9%). CRT response was associated with a reduced risk of VAE (hazard ratio [HR]: 0.27, 95% CI: 0.14-0.55; P<0.001). Super responders to CRT had a lower risk of VAE compared to partial responders (HR: 0.06, 95% CI: 0.02-0.17; P<0.001). Among responders who were VAE free before generator replacement, super responders exhibited a lower incidence of VAE compared to partial responders (HR: 0.13, 95% CI: 0.02-0.82; P=0.04) after generator replacement.</p><p><strong>Conclusion: </strong>In patients with NI-DCM undergoing CRT-D implantation for primary prevention, the CRT response was associated with a 73% decrease in the risk of VAE. Partial responders present a higher rate of VAE compared to super responders, persisting after generator replacement.</p>\",\"PeriodicalId\":55472,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-06-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.acvd.2025.06.003\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.acvd.2025.06.003","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Long-term risk of ventricular arrhythmia in dilated cardiomyopathy by response to cardiac resynchronization therapy.
Background: Improvements in pharmacological treatments and cardiac resynchronization therapy (CRT) raise questions about the benefit of implantable cardioverter defibrillators (ICDs) in non-ischaemic dilated cardiomyopathy (NI-DCM). In this context, the long-term incidence of ventricular arrhythmia events (VAEs) by response to CRT remains under-reported.
Aims: To assess the long-term risk of VAE by response to CRT in patients with NI-DCM.
Methods: Patients who underwent CRT-defibrillator (CRT-D) implantation for primary prevention of NI-DCM (left ventricular ejection fraction [LVEF]≤35%, bundle branch block>130ms) from February 2002 to January 2020 were retrospectively included. CRT response was defined as an increase in LVEF≥10%, with LVEF≥35% at first transthoracic echocardiography (TTE) evaluation. VAE was defined as a sudden arrhythmic death, sustained ventricular arrhythmia or device-treated ventricular arrhythmia, occurring after the first TTE evaluation.
Results: A total of 192 patients (mean age 61years, 68% female, mean LVEF 25%) were included and followed for a median of 91months. Median time to first TTE evaluation after CRT-D implantation was 14months. The overall incidence of VAE was 18.8% (annual rate of 2.9%). CRT response was associated with a reduced risk of VAE (hazard ratio [HR]: 0.27, 95% CI: 0.14-0.55; P<0.001). Super responders to CRT had a lower risk of VAE compared to partial responders (HR: 0.06, 95% CI: 0.02-0.17; P<0.001). Among responders who were VAE free before generator replacement, super responders exhibited a lower incidence of VAE compared to partial responders (HR: 0.13, 95% CI: 0.02-0.82; P=0.04) after generator replacement.
Conclusion: In patients with NI-DCM undergoing CRT-D implantation for primary prevention, the CRT response was associated with a 73% decrease in the risk of VAE. Partial responders present a higher rate of VAE compared to super responders, persisting after generator replacement.
期刊介绍：
The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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