Sudden Cardiac Death Prediction in Non-ischemic Dilated Cardiomyopathy: a Multiparametric and Dynamic Approach

Abstract

Purpose of review: Sudden cardiac death is recognised as a devastating consequence of non-ischaemic dilated cardiomyopathy. Although implantable cardiac defibrillators offer protection against some forms of sudden death, the identification of patients in this population most likely to benefit from this therapy remains challenging and controversial. In this review, we evaluate current guidelines and explore established and novel predictors of sudden cardiac death in patients with non-ischaemic dilated cardiomyopathy.

Recent findings: Current international guidelines for primary prevention implantable defibrillator therapy do not result in improved longevity for many patients with non-ischemic cardiomyopathy and severe left ventricular dysfunction. More precise methods for identifying higher-risk patients that derive true prognostic benefit from this therapy are required. Dynamic and multi-parametric characterization of myocardial, electrical, serological and genetic substrate offers novel strategies for predicting major arrhythmic risk. Balancing the risk of non-sudden death offers an opportunity to personalize therapy and avoid unnecessary device implantation for those less likely to derive benefit.

Keywords: Dilated cardiomyopathy; Sudden cardiac death.

Fig. 1

Contributory factors conferring risk of sudden or non-sudden death in patients with dilated cardiomyopathy. LGE-CMR, late gadolinium enhancement cardiovascular magnetic resonance; MTWA, microvolt T wave alternans; NHYA, New York Heart Association; SCD, sudden cardiac death; SHFM, Seattle Heart Failure Model; SPRM, Seattle Proportional Risk Model; ST2, suppression of tumorigenicity; FLNC, filamin C; DSP, desmoplakin; TTN, titin; LMNA, lamin AC