Electron Microscopic Findings Predict Clinical Outcomes in Patients with Non-Ischaemic Cardiomyopathy

Higuchi, R; Konishi, S; Ohtani, T; Sera, F; Chimura, M; Kanzaki, M; Katsimichas, T; Seo, M; Watanabe, T; Okumura, T; Murohara, T; Takahama, H; Okada, A; Izumi, C; Hatano, M; Komuro, I; Ikeda, Y; Asano, Y; Ishibashi-Ueda, H; Sakata, Y

doi:10.1002/ehf2.15255

Electron Microscopic Findings Predict Clinical Outcomes in Patients with Non-Ischaemic Cardiomyopathy

ESC Heart FailPublished 2 Mar 2025multicentre, prospective, observational study

Main finding · Cardiac events (cardiac death or left ventricular assist device implantation), by nuclear envelopeResultOdds ratio 2.05 95% CI 0.40–10.6

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Authors' conclusion

Discontinuous nuclear envelopes were associated with a reduced LVRR rate, whereas injured myofilaments were correlated with higher 1 year cardiac events and a decreased LVRR. Evaluation of electron microscopic images in diagnostic endomyocardial biopsy can facilitate risk stratification of NICM or DCM with reduced EF.

Study context

Population: Patients with non-ischaemic cardiomyopathy (NICM) with reduced ejection fraction (EF) < 40%, scheduled for diagnostic endomyocardial biopsy and optimization of medical therapiesenrolled, 148 finally analysed
Participants: 170 patients

Exposure: Discontinuous vs continuous nuclear envelopes; injured vs preserved myofilaments
Discontinuous nuclear envelopesn = 17
Injured myofilamentsn = 46
Outcome: Cardiac events:
Cardiac death
Left ventricular assist device implantation
by nuclear envelope
Follow-up: 1 year

Main finding

As reported in the abstract

Odds ratio

2.05

95% CI 0.40–10.6

P = 0.391

By group

Discontinuous nuclear envelopes12%

Continuous nuclear envelopes6%

Discontinuous nuclear envelopesvs continuous nuclear envelopes

OR 2.05 (95% CI 0.40–10.6); P = 0.391

Observational data: associations, not effects.

Further findings

Outcome	Discontinuous nuclear envelopes	Continuous nuclear envelopes	Injured myofilaments	Preserved myofilaments	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
LVRR (EF > 35% with a 10% unit absolute increase), by nuclear envelope · 1 yearDiscontinuous nuclear envelopesvs continuous nuclear envelopes	24%	52%	— not stated in the abstract	— not stated in the abstract	0.050.21520	0.29 (0.08–0.92)	P = 0.036
Cardiac events, by myofilaments · 1 yearInjured myofilamentsvs preserved myofilaments	— not stated in the abstract	— not stated in the abstract	15%	3%	0.050.21520	6.64 (1.32–33.5)	P = 0.022
LVRR, by myofilaments · 1 yearInjured myofilamentsvs preserved myofilaments	— not stated in the abstract	— not stated in the abstract	15%	64%	0.050.21520	0.10 (0.04–0.25)	P < 0.001
					0.050.21520Odds ratio (log scale)

— not stated in the abstract

Associations in patients finally diagnosed with dilated cardiomyopathy (DCM)

These associations between electron microscopic findings and clinical outcomes persisted, even in patients who were finally diagnosed with DCM

Original publication

Electron Microscopic Findings Predict Clinical Outcomes in Patients with Non-Ischaemic Cardiomyopathy. ESC Heart Fail. Published 2 March 2025. doi:10.1002/ehf2.15255

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