The study was performed in accordance with the principles of the Declaration of Helsinki. Written informed consent was waived due to the retrospective nature of this study by the Ethics Committee of Fuwai Hospital. This was a retrospective study approved by the Ethics Committee of Fuwai Hospital. Therefore, we aimed to analyse DCM in our medical centre to explore whether NSIVCD is an independent prognostic factor, utilizing measurement of cardiac morphology, cardiac function, myocardial fibrosis, and myocardial deformation by CMR. This distinctive technology differs from morphology, haemodynamics, and cardiac function methods. Moreover, CMR myocardial strain represents an established approach in evaluating DCM and can be used to quantify myocardial deformation. As a quantitative evaluation of myocardial fibrosis, LGE by CMR is increasingly being considered in the diagnosis and prognosis of DCM because invasive endocardial biopsy is seldom performed. Previous studies have shown that patients with DCM with regional fibrosis identified by cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging methods have adverse outcomes. Some studies included NSIVCD but often in small sample sizes or subgroup analyses. Some studies have used a widened QRS complex duration to analyse the outcomes, not distinguishing NSIVCD from LBBB by a morphological pattern of the QRS complex. The outcome of DCM with NSIVCD has not been clarified. NSIVSD is defined as QRS duration ≥ 110 ms in adults who do not meet the criteria for LBBB or RBBB. In addition to LBBB, there are two other intraventricular conduction delays (IVCDs) with widened QRS complexes, including right branch bundle block (RBBB) and nonspecific intraventricular conduction delay (NSIVCD). The results of several prior clinical trials have already indicated that LBBB is an independent prognostic factor in DCM and is associated with high mortality. Left bundle branch block (LBBB) is a common arrhythmia in DCM patients and is characterized by a widened QRS complex. In addition to left ventricular ejection fraction (LVEF), it has been reported that arrhythmias play an important role in the outcome of DCM. It is very important to identify the latent prognostic predictors of DCM. In addition to LBBB, NSIVCD was an unfavourable prognostic marker in patients with DCM, independent of LVEDDI, NYHA class, LVEF, LGE%, and GLS.ĭilated cardiomyopathy (DCM) is the most common cause of heart failure and cardiac transplantation worldwide, with a reported 5-year mortality of 21–23%. 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. In Kaplan‒Meier analysis, patients with NSIVCD and LBBB showed higher event rates than patients without IVCD, while RBBB patients did not. Of 548 DCM patients, there were 398 males (72.6%), and the average age was 46 ± 15 years, ranging from 18 to 76 years. The associations between different patterns of IVCD and the outcomes of DCM were analysed by Kaplan‒Meier analysis and Cox proportional hazards regression analysis. 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 cohort was divided into four groups: 87 with LBBB, 27 with RBBB, 61 with NSIVCD, and 373 without intraventricular conduction delay (IVCD). MethodsĪ total of 548 DCM patients who underwent cardiovascular magnetic resonance imaging (CMR) from January 2016 to December 2017 were consecutively enrolled. We aimed to evaluate the prognosis of DCM with NSIVCD. However, prognostic data on nonspecific intraventricular conduction delay (NSIVCD) are still limited and conflicting. Left bundle branch block (LBBB) has been confirmed to be independently associated with adverse outcomes in dilated cardiomyopathy (DCM).
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