Europace. 2025 Nov 8:euaf279. doi: 10.1093/europace/euaf279. Online ahead of print.
ABSTRACT
BACKGROUND: The prognostic significance of arrhythmias and conduction disorders on ambulatory ECG in recently diagnosed genetic versus non-genetic dilated cardiomyopathy (DCM) remains unknown.
OBJECTIVE: To compare the prevalence of abnormalities on ambulatory ECG monitoring between genetic and non-genetic DCM patients and evaluate the predictive value for malignant ventricular adverse events (MVAE).
METHODS: Clinical and ambulatory ECG data were collected from 354 genotyped DCM probands, with a median follow-up of 8 years (IQR:5-9years). MVAE was defined as ventricular fibrillation, sustained ventricular tachycardia, anti-tachy pacing, appropriate device therapy, or sudden cardiac death. C-statistics assessed the predictive performance of the regression models.
RESULTS: 123 (35%) patients carried a (likely) pathogenic variant. Abnormalities on ambulatory ECG were more frequent in genetic DCM patients (80%) compared to non-genetic DCM (67%; p=0.013). Permanent atrial fibrillation (perAF), paroxysmal supraventricular tachycardia (parox-SVT) and non-sustained ventricular tachycardia (NSVT) were more frequent in genetic DCM patients (p=0.041, <0.001 and <0.001). Structural cardiac parameters showed minimal group differences. Using Cox-proportional hazard analyses to predict MVAE, ambulatory ECG variables (perAF, AV-block, NSVT, >500 premature ventricular complexes (PVC)/24 hours) had an AUC of 0.768 in genetic and 0.628 in non-genetic DCM patients (p=0.044). PVC burden was only predictive for MVAE in genetic DCM. Adding clinical variables provided little incremental predictive value for genetic versus non-genetic DCM (AUC Δ+0.004 versus Δ+0.150, respectively).
CONCLUSION: Ambulatory ECG monitoring abnormalities are prevalent in genetic DCM patients. In contrast to non-genetic DCM patients, ambulatory ECG parameters have an important predictive value to determine the risk of MVAE in genetic DCM patients.
PMID:41206691 | DOI:10.1093/europace/euaf279
