Combined Imaging and In Silico Simulations to Predict Ventricular Arrhythmia Risk in Nonischemic Cardiomyopathy*

摘要

Nonischemic dilated cardiomyopathy (NIDCM) is a heterogeneous diagnosis, and current risk stratification strategies for ventricular tachycardia (VT)/fibrillation (VF) are suboptimal. Although reduced left ventricular ejection fraction (LVEF) is typically indicative of the severity of NIDCM, it has a limited role in predicting sudden cardiac death risk (1). Current guidelines (2) use LVEF in patients expected to survive for at least 1 year to identify those for whom an implantable cardioverter-defibrillator (ICD) is indicated for sudden cardiac death prevention. The DANISH (Defibrillator Implantation in Patients With Nonischemic Systolic Heart Failure) study importantly found limited survival benefit in NIDCM patients (3) with ICDs, reflecting the poor risk stratification schemes currently available, especially when cardiac resynchronization is instituted. Simply stated, there is a need for additional prognostic factors to improve risk stratification and guide therapeutic interventions in patients with NIDCM.