Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Card Electrophysiol Clin. 2023 Sep;15(3):379-390. doi: 10.1016/j.ccep.2023.04.009. Epub 2023 May 27.
Left ventricular ejection fraction-based arrhythmic risk stratification in nonischemic cardiomyopathy (NICM) is insufficient and has led to the failure of primary prevention implantable cardioverter defibrillator trials, mainly due to the inability of selecting patients at high risk for sudden cardiac death (SCD). Cardiac magnetic resonance offers unique opportunities for tissue characterization and has gained a central role in arrhythmic risk stratification in NICM. The presence of myocardial scar, denoted by late gadolinium enhancement, is a significant, independent, and strong predictor of ventricular arrhythmias and SCD with high negative predictive value. T1 maps and extracellular volume fraction, which are able to quantify diffuse fibrosis, hold promise as complementary tools but need confirmatory results from large studies.
基于左心室射血分数的非缺血性心肌病（NICM）心律失常风险分层是不充分的，这导致了主要预防植入式心脏复律除颤器试验的失败，主要是因为无法选择患有心脏性猝死（SCD）高风险的患者。心脏磁共振为组织特征提供了独特的机会，并在 NICM 的心律失常风险分层中发挥了核心作用。心肌瘢痕的存在，由晚期钆增强表示，是室性心律失常和 SCD 的一个重要、独立且强烈的预测因子，具有较高的阴性预测值。能够定量弥漫性纤维化的 T1 图谱和细胞外容积分数有望成为补充工具，但需要来自大型研究的确认结果。
