Cardiovascular Research Centre, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
National Heart & Lung Institute, Imperial College London, London, UK.
Curr Cardiol Rep. 2020 Jul 9;22(9):85. doi: 10.1007/s11886-020-01343-9.
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.
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.
非缺血性扩张型心肌病可导致心源性猝死，这是一种毁灭性的后果。尽管植入式心脏除颤器可预防某些类型的猝死，但确定该人群中最有可能从这种治疗中获益的患者仍然具有挑战性和争议性。在这篇综述中，我们评估了当前的指南，并探讨了非缺血性扩张型心肌病患者发生心源性猝死的既定和新型预测因子。
目前，国际上针对原发性预防植入式除颤器治疗的指南并不能使许多患有非缺血性心肌病和严重左心室功能障碍的患者延长寿命。需要更精确的方法来识别从这种治疗中获得真正预后获益的高危患者。心肌、电、血清学和遗传学基质的动态和多参数特征为预测主要心律失常风险提供了新策略。平衡非猝死风险为那些不太可能从中获益的患者提供了个性化治疗和避免不必要的器械植入的机会。
