BACKGROUND The ability to predict recovery of left ventricular ejection fraction (LVEF) in response to guideline-directed therapy among patients with nonischemic cardiomyopathy is desired. We sought to determine whether left ventricular endocardial unipolar voltage measured during invasive electroanatomic mapping could be used to predict LVEF recovery among those with recent-onset nonischemic cardiomyopathy. METHODS We analyzed the left ventricular voltage maps of patients included in the eMAP trial (Electrogram-Guided Myocardial Advanced Phenotyping; NCT03293381), a prospective, nonrandomized, interventional trial conducted at 2 institutions between 2017 and 2020. Patients had recent-onset nonischemic cardiomyopathy defined by LVEF ≤45% and development of symptoms or signs of heart failure within the past 6 months. Detailed voltage maps of the left ventricular endocardium were generated using the CARTO electroanatomic mapping system. Abnormal unipolar amplitude was defined as <8.27 mV. The primary end point was recovery of LVEF (Recovery) defined by a 1-year LVEF ≥50% or ≥45% with ≥10% increase from baseline. RESULTS Of the 29 enrolled patients (median age, 49 years [25th percentile, 39; 75th percentile, 59], 8 females [27.6%]), LVEF recovered in 13 (44.8%) by 1-year follow-up. The percentage of total endocardial surface area with unipolar voltage abnormality (AUA) was significantly lower among Recovery patients than No Recovery patients (18.2% [6.4, 22.4] versus 80.0% [29.5, 90.9]; P=0.004). Percent AUA was associated with lower likelihood of Recovery (odds ratio, 0.64 per 10% increase in AUA; 95% CI, 0.47-0.88; P=0.006). A 28% cutoff value for percent AUA was 92% sensitive and 75% specific with an area under the receiver operating characteristic curve of 0.81 (95% CI, 0.63-0.99; P=0.001) for predicting recovery versus no recovery. The majority of patients (12 of 13; 92.3%) with a percent AUA >28% did not recover. CONCLUSIONS Left ventricular unipolar voltage abnormality is a potent predictor of LVEF recovery among patients recently diagnosed with nonischemic cardiomyopathy. Detailed left ventricular unipolar voltage mapping could therefore be used as a valuable prognostic tool in guiding treatment decisions.

中文翻译：

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单极电压映射预测近期发作的非缺血性心肌病患者左心室射血分数的恢复。


背景 希望能够预测非缺血性心肌病患者对指南指导治疗的反应后左心室射血分数 （LVEF） 的恢复。我们试图确定在侵入性电解剖标测期间测量的左心室心内膜单极电压是否可用于预测近期发作的非缺血性心肌病患者的 LVEF 恢复。方法 我们分析了 eMAP 试验中纳入患者的左心室电压图（电图引导心肌高级表型;NCT03293381），一项前瞻性、非随机、干预性试验，于 2017 年至 2020 年在 2020 个机构进行。患者近期发作的非缺血性心肌病定义为 LVEF ≤45%，并且在过去 6 个月内出现心力衰竭的症状或体征。使用 CARTO 电解剖标测系统生成左心室心内膜的详细电压图。异常单极振幅定义为 <8.27 mV。主要终点是 LVEF （Recovery） 的恢复，定义为 1 年 LVEF ≥50% 或 ≥45%，较基线增加 ≥10%。结果 在 29 例入组患者 （中位年龄 49 岁 [第 25 个百分位数，39;第 75 个百分位数，59] ，8 例女性 [27.6%]） 中，13 例 （44.8%） 的 LVEF 在 1 年随访中恢复。恢复期患者单极电压异常 （AUA） 的总心内膜表面积百分比显著低于未恢复期患者 （18.2% [6.4， 22.4] 对 80.0% [29.5， 90.9];P=0.004）。AUA 百分比与较低的恢复可能性相关（比值比，AUA 每增加 10% 为 0.64;95% CI，0.47-0.88;P=0.006）。AUA 百分比的 28% 截断值为 92% 敏感度和 75% 特异性，受试者工作特征曲线下面积为 0。81 （95% CI，0.63-0.99;P=0.001） 预测恢复与无恢复。大多数 AUA 百分比为 >28% 的患者 （13 例中的 12 例;92.3%） 未恢复。结论 左心室单极电压异常是近期诊断为非缺血性心肌病患者 LVEF 恢复的有效预测指标。因此，详细的左心室单极电压标测可用作指导治疗决策的有价值的预后工具。