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Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy beyond ejection fraction
  1. Antonio Cannatà1,2,
  2. Giulia De Angelis1,
  3. Andrea Boscutti1,
  4. Camilla Normand3,4,
  5. Jessica Artico1,
  6. Piero Gentile1,
  7. Massimo Zecchin1,
  8. Stephane Heymans5,6,7,
  9. Marco Merlo1,
  10. Gianfranco Sinagra1
  1. 1 Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
  2. 2 Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
  3. 3 Cardiology Division, Stavanger University Hospital, Stavanger, Norway
  4. 4 Institute of Internal Medicine, University of Bergen, Bergen, Norway
  5. 5 Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, Belgium
  6. 6 Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
  7. 7 The Netherlands Heart Institute, Utrecht, The Netherlands
  1. Correspondence to Dr Marco Merlo, Cardiovascular Department, Azienda SAnitaria Universitaria Integrata di Trieste, Trieste, Italy; marco.merlo79{at}


Sudden cardiac death and arrhythmia-related events in patients with non-ischaemic dilated cardiomyopathy (NICM) have been significantly reduced over the last couple of decades as a result of evidence-based pharmacological and non-pharmacological therapeutic strategies. Nevertheless, the arrhythmic stratification in patients with NICM remains extremely challenging, and the simple indication based on left ventricular ejection fraction appears to be insufficient. Therefore, clinicians need to go beyond the current criteria for implantable cardioverter-defibrillator implantation in the direction of a multiparametric evaluation of arrhythmic risk. Several parameters for arrhythmic risk stratification, ranging from electrocardiographic, echocardiographic, imaging-derived and genetic markers, are crucial for proper arrhythmic risk stratification and a multiparametric evaluation of risk in patients with NICM. In particular, integration of cardiac magnetic resonance parameters (mostly late gadolinium enhancement) and specific genetic information (ie, presence of LMNA, PLN, FLNC mutations) appears fundamental for proper implementation of the current arrhythmic risk stratification. Finally, a novel approach focused on both arrhythmic risk and prediction of left ventricular reverse remodelling during follow-up might be useful for effective multiparametric and dynamic arrhythmic risk stratification in NICM. In the future, a complete and integrated evaluation might be mandatory to implement arrhythmic risk prediction in patients with NICM and to discriminate the competing risk between heart failure-related events and life-threatening arrhythmias.

  • dilated cardiomyopathy
  • sudden cardiac death
  • arrhythmic risk stratification
  • left ventricular reverse remodeling
  • multiparametric

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  • Contributors All authors have read and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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