Arrhythmic risk stratification in patients with dilated cardiomyopathy and intermediate left ventricular dysfunction

Area of Science:

• Cardiology
• Electrophysiology
• Cardiovascular Medicine

Background:

• Arrhythmic risk stratification in dilated cardiomyopathy (DCM) is challenging, especially with LVEF >35%.
• Optimal medical treatment (OMT) is crucial for managing DCM patients.
• Identifying risk factors for sudden cardiac death or malignant ventricular arrhythmias (SCD/MVAs) is essential.

Purpose of the Study:

• To determine the prevalence of SCD/MVAs in DCM patients considered at low arrhythmic risk.
• To identify predictors of SCD/MVAs in this patient cohort.
• To evaluate the risk associated with an arrhythmogenic profile and left atrial size.

Main Methods:

• Analysis of DCM patients with LVEF >35% and NYHA class I-III after OMT.
• Definition of an arrhythmogenic profile based on syncope, NSVT, PVCs, and ventricular couplets.
• Follow-up for SCD/MVAs as the primary endpoint.

Main Results:

• 8.3% of low-risk DCM patients experienced SCD/MVAs during a median follow-up of 152 months.
• Patients with SCD/MVAs had a higher prevalence of an arrhythmogenic profile and larger left atrium.
• Left atrial end-systolic area and arrhythmogenic profile were independent predictors of SCD/MVAs.

Conclusions:

• A significant number of DCM patients with intermediate LVEF on OMT experience SCD/MVA.
• Left atrial dilatation and an arrhythmogenic pattern are associated with increased SCD/MVA risk.
• These findings aid in refining risk stratification for DCM patients.