Clinic for Cardiology, University Heart and Vascular Center Hamburg Eppendorf, 20246 Hamburg, Germany.
Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany.
Int J Mol Sci. 2021 Jul 1;22(13):7115. doi: 10.3390/ijms22137115.
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.
非缺血性心肌病（NICM）是心律失常和心源性猝死（SCD）的最重要原因之一。既往研究表明，与缺血性心肌病（ICM）相比，NICM 患者植入式心脏复律除颤器（ICD）治疗的获益较低。然而，目前的指南在推荐 ICD 植入时并没有对这两个亚组进行区分。因此，需要进行风险分层以确定可能从 ICD 治疗中获益的 NICM 患者亚组。已经提出了各种预测因子，包括基因突变、左心室射血分数（LVEF）、左心室舒张末期容积（LVEDD）和 T 波交替（TWA）。除了这些参数之外，心血管磁共振成像（CMR）具有进一步改善风险分层的潜力。CMR 允许对心脏功能和心肌组织成分进行全面分析。一系列 CMR 参数与 SCD 相关。适用的示例包括晚期钆增强（LGE）、T1 弛豫时间和心肌应变。本综述评估了 NICM 中 SCD 的流行病学方面、CMR 在风险分层中的作用以及由此产生的 ICD 植入适应证。
