Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy beyond ejection fraction

Abstract

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.

Contemporary survival trends and aetiological characterization in non‐ischaemic dilated cardiomyopathy

“…Indeed, ICD implantation was an independent prognostic factor for all the three main outcomes considered. Our results highlight the overall prognostic value of ICD implantation in a highly selected DCM population, in line with the results of recent studies 20,21 . The last two periods of enrolment showed comparable outcomes when overall survival as well as heart failure‐related events were considered in the analysis, supporting the importance of reducing fatal arrhythmic events in this population.…”

A clinical score for predicting left ventricular reverse remodelling in patients with dilated cardiomyopathy

“…It is a well-recognized parameter for predicting arrhythmic events, mortality, and LVRR in patients with DCM. 27,28 Furthermore, a wide QRS duration was reported to be associated with diffuse myocardial fibrosis on CMR. 28 QRS duration may reflect the severity of LV dysfunction in addition to conduction abnormalities.…”

“…Life-threatening arrhythmias occur during the first 6 months after a diagnosis of DCM in approximately 2% of unprotected patients, and 70% of these arrhythmias occur in the first 90 days. 27 An ICD is recommended in patients with DCM, symptomatic heart failure (NYHA class II-III), or an LVEF ≤35% despite ≥3 months of treatment with optimal medical therapy. 30 However, LVRR typically begins after 6 months, to be completed for 12 to 24 months.…”

The Auxiliary Diagnostic Value of a Novel Wearable Electrocardiogram-Recording System for Arrhythmia Detection: Diagnostic Trial

“…The AMAZFIT ® for AF was found to have a sensitivity of 93.28%, a specificity of 95.35%, a PPV of 93.28%, an NPV of 95.35%, a PLR 20.06 and an NLR 0.07. Rajakariar et al ( 23 ) reported sensitivity and specificity using the Kardia Band for identifying AF was 94.4 and 81.9% respectively, with positive and negative predictive values of 54.8 and 98.4%, respectively. These findings indicate that the AMAZFIT ® has excellent sensitivity and specificity for the detection of an irregular pulse from AF.…”