Dilated cardiomyopathy (DCM) is a common yet challenging cardiac disease. Great strides have been made in improving DCM prognosis due to heart failure but sudden cardiac death (SCD) due to ventricular arrhythmias remains significant and challenging to predict. High-risk patients can be effectively managed with implantable cardioverter defibrillators (ICDs) but because identification of what is high risk is very limited, many patients unnecessarily experience the morbidity associated with an ICD implant and many others are not identified and have preventable mortality. Current guidelines recommend use of left ventricular ejection fraction and New York Heart Association class as the main markers of risk stratification to identify patients who would be at higher risk of SCD. However, when analysing the data from the trials that these recommendations are based on, the number of patients in whom an ICD delivers appropriate therapy is modest. In order to improve the effectiveness of therapy with an ICD, the patients who are most likely to benefit need to be identified. This review article presents the evidence behind current guideline-directed SCD risk markers and then explores new potential imaging, electrophysiological and genetic risk markers for SCD in DCM.
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Contributors The authors confirm contribution to the paper as follows: conception—VP; draft manuscript preparation—VP, WN, ZV, XL and GAN. All authors reviewed and approved the final version of the manuscript.
Funding VP and ZV are supported by the NIHR Leicester Biomedical Research Centre with Research Fellowships. GAN is supported by a British Heart Foundation Programme Grant (RG/17/3/32774). XL, WN and GAN are supported by a Medical Research Council Biomedical Catalyst Developmental Pathway Funding Scheme (MR/S037306/1).
Competing interests GAN reports grants from Boston Scientific, grants and personal fees from Abbott, personal fees from Biosense Webster, personal fees from Catheter Precision, personal fees from Daiichi Sankyo, outside the submitted work. The University of Leicester has applied for patents for the Regional Restitution Instability Index and Peak ECG Restitution Slope techniques on behalf of WN and GAN.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.