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A. García-Álvarez

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Sep 2026

Arrhythmic Risk Stratification According to LGE Corridors and Genetics in Nonischemic Dilated Cardiomyopathy.

BACKGROUND Fibrosis assessed through late gadolinium enhancement (LGE) in cardiac magnetic resonance imaging and genetics have emerged as risk markers of ventricular arrhythmias in nonischemic dilated cardiomyopathy. Conduction corridors detected within LGE (ie, LGE corridors) have been associated with ventricular arrhythmias in ischemic cardiomyopathy. This study sought to evaluate major ventricular arrhythmic events (MVAs) according to the presence of LGE corridors combined with high-risk genotypes (HRGs) in nonischemic dilated cardiomyopathy. METHODS We studied consecutive patients with nonischemic dilated cardiomyopathy from 22 European centers who had undergone genetic testing and cardiac magnetic resonance imaging. RESULTS Among 925 patients (mean age, 54.5 years [interquartile range, 43.7-63.9 years]; 64% men; mean left ventricular ejection fraction, 37.6% [26.9%-44.8%]; LGE in 24.3%), LGE corridors were present in 160 patients (17.3%), and HRG in 119 (12.9%). After a median follow-up of 5.4 years (interquartile range, 3.3-7.7), 95 patients (10.3%) experienced an MVA. In multivariable competing-risk analysis adjusted for left ventricular ejection fraction and extent of LGE, the number of LGE corridors and HRGs were independently associated with MVA (subdistribution hazard ratio, 1.25 [95% CI, 1.11-1.42]; P<0.001; and subdistribution hazard ratio, 2.28 [95% CI, 1.32-3.96]; P=0.003, respectively). An optimal cutoff of ≥4 LGE corridors predicted MVA. A stepwise risk stratification algorithm to predict MVA integrating LGE, the presence of ≥4 LGE corridors, and HRG outperformed left ventricular ejection fraction ≤35%-based classification proposed in guidelines (5-year time-dependent area under the curve, 0.72 [95% CI, 0.65-0.78] versus 0.57 [95% CI, 0.51-0.64]; P=0.001), showing a progressive increase in arrhythmic risk across categories (Gray test P<0.001), and allowing clinically meaningful arrhythmic risk classification. CONCLUSIONS LGE corridors and HRGs provide additive value for arrhythmic risk stratification in patients with nonischemic dilated cardiomyopathy. These findings support MVA multiparametric prediction over the traditional left ventricular ejection fraction ≤35% threshold.

Noemí Ramos-López, N. Mora-Ayestarán, Juan Pablo Ochoa et al. · Circulation · 0 citations

#protein folding Open access Sep 2026

Haptoglobin and Immunoglobulin A2 Predict Cardiovascular Risk in Asymptomatic Subjects: The BioImage Study.

BACKGROUND Plasma levels of haptoglobin and IgA2 (immunoglobulin A2) have recently been associated with subclinical atherosclerosis in European cohorts. We sought to validate these findings in an American population and to determine whether these biomarkers predict all-cause mortality or major cardiovascular adverse events beyond traditional risk scales (Framingham Risk Score) or vascular imaging. METHODS We analyzed 5328 asymptomatic US adults (mean age 69 years, 56.9% women) from the BioImage study (A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population; NCT00738725). Subjects underwent carotid plaque burden assessment by ultrasound, coronary artery calcium by computed tomography, and baseline plasma haptoglobin and IgA2 levels measurement by immunoturbidimetry. The end point was a composite of major cardiovascular adverse events and all-cause death during follow-up. RESULTS Haptoglobin and IgA2 correlated significantly with carotid plaque burden and coronary artery calcium, independent of Framingham Risk Score. After a median follow-up of 4.6 years, 466 participants (8.8%) experienced the composite outcome. Haptoglobin and IgA2 independently predicted the outcome, and associations remained significant after further adjustment for carotid plaque burden or coronary artery calcium. Similar results were observed for predictive capacity of high-sensitivity C-reactive protein. Individuals with high levels of all biomarkers (above the median) had a 2-fold higher event rate compared with those with low levels. Combined biomarker assessment, albeit modestly, significantly improved risk prediction beyond Framingham Risk Score and imaging. CONCLUSIONS Haptoglobin and IgA2 predict the composite outcome of major cardiovascular adverse events and all-cause death, independently to Framingham Risk Score, in asymptomatic American adults. Their measurement, alone or in combination with imaging, may enhance cardiovascular risk stratification in primary prevention.

A. García-Álvarez, V. Fuster, Estefanía Núñez et al. · Journal of the American Hear... · 0 citations