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Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy beyond ejection fraction
- Publication Year :
- 2020
-
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.
- Subjects :
- Cardiomyopathy, Dilated
STIMULATION
medicine.medical_specialty
PROGNOSIS
IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR
multiparametric
030204 cardiovascular system & hematology
Global Health
arrhythmic risk stratification
dilated cardiomyopathy
left ventricular reverse remodeling
sudden cardiac death
Risk Assessment
Ventricular Function, Left
Sudden cardiac death
LMNA
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Late gadolinium enhancement
Humans
In patient
030212 general & internal medicine
FLNC
MUTATION
Ejection fraction
Arrhythmic risk
Ventricular Remodeling
business.industry
Incidence
LATE GADOLINIUM ENHANCEMENT
Dilated cardiomyopathy
Stroke Volume
medicine.disease
INDUCIBILITY
Survival Rate
NONSUSTAINED VENTRICULAR-TACHYCARDIA
Death, Sudden, Cardiac
Cardiology
TRIAL
Cardiology and Cardiovascular Medicine
business
PRIMARY PREVENTION
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....56b4b345339fda62855e92baec41ea41