The need to modify patient selection to improve the benefits of implantable cardioverter-defibrillator for primary prevention of sudden death in non-ischaemic dilated cardiomyopathy

Marcello Disertori, Silvia Quintarelli, Silvia Mazzola, Valentina Favalli, Nupoor Narula, Eloisa Arbustini

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Left ventricular ejection fraction (LVEF) ≤35% is a major determinant for implantable cardioverter-defibrillator (ICD) therapy for primary prevention of sudden death (SD) in patients with non-ischaemic dilated cardiomyopathy (DCM). However, as a risk marker for SD, low LVEF has limited sensibility and specificity. Selecting patients according to the current guidelines shows that most DCM patients do not actually benefit from ICD implantation and may suffer collateral effects and that many patients who are at risk of SD are not identified because a large proportion of SD patients exhibit only mildly depressed LVEF. Identifying patients who are at risk of SD on the sole basis of LVEF appears to be an over-simplification which does not maximize the benefit of ICD therapy. Owing to the complexity of the substrates underlying SD, multiple risk factors used in combination could probably predict the risk of SD better than any individual risk marker. Among non-invasive tests, microvolt T-wave alternans and cardiac magnetic resonance with late gadolinium enhancement may contribute to a better SD risk stratification by their high negative predictive value. Genetics may further contribute because approximately one-third of DCM patients have evidence of familial disease, and mutations in some known disease genes, including LMNA, have been associated with a high risk of SD. In this review, we critically analyse the current indications for ICD implantation and we explore existing knowledge about potentially predicting markers for selecting DCM patients who are at high and low risk of SD.

Original languageEnglish
Pages (from-to)1693-1701
Number of pages9
JournalEuropace
Volume15
Issue number12
DOIs
Publication statusPublished - Dec 2013

Fingerprint

Implantable Defibrillators
Dilated Cardiomyopathy
Primary Prevention
Sudden Death
Patient Selection
Stroke Volume
Gadolinium
Magnetic Resonance Spectroscopy
Guidelines
Mutation

Keywords

  • Cardiac magnetic resonance
  • Cardioverter defibrillator
  • Dilated cardiomyopathy
  • Hereditability
  • Sudden death primary prevention
  • T-wave alternans

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

The need to modify patient selection to improve the benefits of implantable cardioverter-defibrillator for primary prevention of sudden death in non-ischaemic dilated cardiomyopathy. / Disertori, Marcello; Quintarelli, Silvia; Mazzola, Silvia; Favalli, Valentina; Narula, Nupoor; Arbustini, Eloisa.

In: Europace, Vol. 15, No. 12, 12.2013, p. 1693-1701.

Research output: Contribution to journalArticle

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