Zipse Matthew M, Tzou Wendy S
University of Colorado, Section of Cardiac Electrophysiology, Aurora, CO, USA.
J Cardiovasc Electrophysiol. 2017 Nov;28(11):1361-1366. doi: 10.1111/jce.13284. Epub 2017 Jul 26.
Sudden cardiac death (SCD) risk assessment among patients with nonischemic cardiomyopathy (NICM) has been has been less straightforward than for patients with ischemic cardiomyopathy. The common surrogate that has been associated with highest SCD risk for all cardiomyopathies, and which has been universally used to guide implantation of primary-prevention implantable cardioverter-defibrillators (ICDs), is left ventricular ejection fraction (LVEF) ≤35%. However, this practice has been called into question, especially in light of recent trials suggesting that ICD treatment may not be of additional survival benefit among those with NICM treated with optimal medical therapy. This Clinical Review attempts to offer refinements to the current practice of SCD risk assessment among patients with NICM, with specific focus on importance of NICM etiology and efforts to identify myocardial scarring and arrhythmogenic substrate, both of which may provide greater information about SCD risk than the LVEF alone. These concepts are illustrated further as they apply to hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and cardiac sarcoidosis, all of which are increasingly recognized NICM substrates associated with SCD and for which refinements for assessing risk are lacking in conventional guidelines.
与缺血性心肌病患者相比，非缺血性心肌病（NICM）患者的心脏性猝死（SCD）风险评估一直不那么直接。对于所有心肌病而言，与最高SCD风险相关且一直普遍用于指导一级预防植入式心律转复除颤器（ICD）植入的常见替代指标是左心室射血分数（LVEF）≤35%。然而，这种做法受到了质疑，特别是鉴于最近的试验表明，在接受最佳药物治疗的NICM患者中，ICD治疗可能不会带来额外的生存益处。本临床综述试图对目前NICM患者SCD风险评估的做法进行改进，特别关注NICM病因的重要性以及识别心肌瘢痕和致心律失常基质的努力，这两者可能比单独的LVEF提供更多关于SCD风险的信息。这些概念在肥厚型心肌病、致心律失常性右心室心肌病和心脏结节病中的应用将进一步说明，所有这些疾病越来越被认为是与SCD相关的NICM基质，而传统指南中缺乏评估这些疾病风险的改进方法。
