Cardiac Magnetic Resonance as Risk Stratification Tool in Non-Ischemic Dilated Cardiomyopathy Referred for Implantable Cardioverter Defibrillator Therapy—State of Art and Perspectives

Author:

Argentiero Adriana1ORCID,Carella Maria Cristina1,Mandunzio Donato1ORCID,Greco Giulia1,Mushtaq Saima2,Baggiano Andrea2ORCID,Fazzari Fabio2,Fusini Laura2ORCID,Muscogiuri Giuseppe3,Basile Paolo1ORCID,Siena Paola1,Soldato Nicolò1ORCID,Napoli Gianluigi1,Santobuono Vincenzo Ezio1ORCID,Forleo Cinzia1ORCID,Garrido Eduard Claver45,Di Marco Andrea45ORCID,Pontone Gianluca26,Guaricci Andrea Igoren1ORCID

Affiliation:

1. University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy

2. Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy

3. Department of Radiology, ASST Papa Giovanni XIII, 24127 Bergamo, Italy

4. Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain

5. Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain

6. Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy

Abstract

Non-ischemic dilated cardiomyopathy (DCM) is a disease characterized by left ventricular dilation and systolic dysfunction. Patients with DCM are at higher risk for ventricular arrhythmias and sudden cardiac death (SCD). According to current international guidelines, left ventricular ejection fraction (LVEF) ≤ 35% represents the main indication for prophylactic implantable cardioverter defibrillator (ICD) implantation in patients with DCM. However, LVEF lacks sensitivity and specificity as a risk marker for SCD. It has been seen that the majority of patients with DCM do not actually benefit from the ICD implantation and, on the contrary, that many patients at risk of SCD are not identified as they have preserved or mildly depressed LVEF. Therefore, the use of LVEF as unique decision parameter does not maximize the benefit of ICD therapy. Multiple risk factors used in combination could likely predict SCD risk better than any single risk parameter. Several predictors have been proposed including genetic variants, electric indexes, and volumetric parameters of LV. Cardiac magnetic resonance (CMR) can improve risk stratification thanks to tissue characterization sequences such as LGE sequence, parametric mapping, and feature tracking. This review evaluates the role of CMR as a risk stratification tool in DCM patients referred for ICD.

Publisher

MDPI AG

Subject

General Medicine

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