RT Journal Article
SR Electronic
T1 Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy beyond ejection fraction
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 656
OP 664
DO 10.1136/heartjnl-2019-315942
VO 106
IS 9
A1 Cannatà, Antonio
A1 De Angelis, Giulia
A1 Boscutti, Andrea
A1 Normand, Camilla
A1 Artico, Jessica
A1 Gentile, Piero
A1 Zecchin, Massimo
A1 Heymans, Stephane
A1 Merlo, Marco
A1 Sinagra, Gianfranco
YR 2020
UL http://heart.bmj.com/content/106/9/656.abstract
AB 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.