Regional Cardiac Denervation Predicts Sustained Ventricular Arrhythmias in Nonischemic Cardiomyopathy Patients Without LGE on CMR Imaging

Jungen, C; Chen, HS; Wijnmaalen, AP; Dibbets-Schneider, P; Meretta, A; Piers, SR; Kimura, Y; Androulakis, AFA; van der Geest, RJ; de Geus-Oei, LF; Mertens, BJA; Scholte, AJHA; Lamb, HJ; Jongbloed, MRM; Zeppenfeld, K

doi:10.1161/circep.124.013150

Arrhythmias & electrophysiology

Regional Cardiac Denervation Predicts Sustained Ventricular Arrhythmias in Nonischemic Cardiomyopathy Patients Without Late Gadolinium Enhancement (LGE) on CMR Imaging

Circ Arrhythm ElectrophysiolPublished 25 Jul 2025Consecutive patients from the Leiden Nonischemic Cardiomyopathy Study

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Authors' conclusion

In patients with nonischemic cardiomyopathy without LGE the extent of regional denervation may contribute to risk stratification for VA.

Study context

Population: Patients with nonischemic cardiomyopathy who underwent programmed electrical stimulation, LGE-cardiac magnetic resonance, and 123-iodine meta-iodobenzylguanidine imaging between 2011 and 201935 had no LGE
Participants: 75 patients

Comparison: Regional and global sympathetic denervation on 123-iodine meta-iodobenzylguanidine imaging and occurrence of ventricular arrhythmias (VA), in patients without and with LGE
Patients without LGEn = 35
Patients with LGEn = 40
Outcome: Sustained ventricular arrhythmias (VA)
Follow-up: 4.5±1.6 years of mean

Main finding

As reported in the abstract

Patients without LGE23%8 of 35 of 35

Patients with LGE45%18 of 40 of 40

Further findings

Outcome	← Lower ←→ Higher →	Hazard ratio (95% CI)	P value
Number of DS and occurrence of VA in patients without LGE (bivariate analysis)Per denervated segment · bivariate analysis	0.512	1.25 (1.06–1.46)	P = 0.006
	0.512Hazard ratio (log scale)

Outcome	Estimate	P value
Regional sympathetic denervation, patients without LGE: with VA versus without VAWith VA vs without VA	median number of DS 8 [IQR, 7-10] versus 2 [IQR, 1-5]	P = 0.004
Regional sympathetic denervation, patients without LGE: with VA versus without VAWith VA vs without VA	median ratio of DS 0.5 [IQR, 0.5-0.7] versus 0.2 [IQR, 0.1-0.4]	P = 0.007
Regional sympathetic denervation, patients without LGE: with VA versus without VAWith VA vs without VA	median defect score 36 [IQR, 30-41] versus 18 [IQR, 14-24]	P = 0.01
Regional sympathetic denervation, patients without LGE: with VA versus without VAWith VA vs without VA	median weighted denervation size 47 [IQR, 38-54] versus 22 [IQR, 14-30]	P = 0.01

Denervation of ≥7 segments to identify patients without LGE at risk for VA

Area under the curve: 0.83
Sensitivity: 88%
Specificity: 89%

Innervation state and VA among patients with LGE

Not associated with VA during follow-up

Original publication

Regional Cardiac Denervation Predicts Sustained Ventricular Arrhythmias in Nonischemic Cardiomyopathy Patients Without LGE on CMR Imaging. Circ Arrhythm Electrophysiol. Published 25 July 2025. doi:10.1161/circep.124.013150

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