CMR-Based Risk Stratification of Sudden Cardiac Death and Use of Implantable Cardioverter–Defibrillator in Non-Ischemic Cardiomyopathy

L Keil, C Chevalier, P Kirchhof, S Blankenberg… - International Journal of …, 2021 - mdpi.com
L Keil, C Chevalier, P Kirchhof, S Blankenberg, G Lund, K Müllerleile, C Magnussen
International Journal of Molecular Sciences, 2021mdpi.com
Non-ischemic cardiomyopathy (NICM) is one of the most important entities for arrhythmias
and sudden cardiac death (SCD). Previous studies suggest a lower benefit of implantable
cardioverter–defibrillator (ICD) therapy in patients with NICM as compared to ischemic
cardiomyopathy (ICM). Nevertheless, current guidelines do not differentiate between the two
subgroups in recommending ICD implantation. Hence, risk stratification is required to
determine the subgroup of patients with NICM who will likely benefit from ICD therapy …
Non-ischemic cardiomyopathy (NICM) is one of the most important entities for arrhythmias and sudden cardiac death (SCD). Previous studies suggest a lower benefit of implantable cardioverter–defibrillator (ICD) therapy in patients with NICM as compared to ischemic cardiomyopathy (ICM). Nevertheless, current guidelines do not differentiate between the two subgroups in recommending ICD implantation. Hence, risk stratification is required to determine the subgroup of patients with NICM who will likely benefit from ICD therapy. Various predictors have been proposed, among others genetic mutations, left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic volume (LVEDD), and T-wave alternans (TWA). In addition to these parameters, cardiovascular magnetic resonance imaging (CMR) has the potential to further improve risk stratification. CMR allows the comprehensive analysis of cardiac function and myocardial tissue composition. A range of CMR parameters have been associated with SCD. Applicable examples include late gadolinium enhancement (LGE), T1 relaxation times, and myocardial strain. This review evaluates the epidemiological aspects of SCD in NICM, the role of CMR for risk stratification, and resulting indications for ICD implantation.
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