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Emerging Techniques for Risk Stratification in Nonischemic Dilated Cardiomyopathy: JACC Review Topic of the Week
Benjamin A Marrow1, Stuart A Cook2, Sanjay K Prasad3
1Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
Insights
Dilated cardiomyopathy (DCM) risk stratification needs improvement. This review explores advanced cardiac imaging, genetics, biomarkers, and exercise testing for better prediction of sudden cardiac death and pump failure in DCM patients.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Dilated cardiomyopathy (DCM) is a prevalent condition associated with high mortality from sudden cardiac death and pump failure.
- Conventional risk markers like left ventricular ejection fraction have shown limited predictive accuracy in DCM clinical trials.
Purpose of the Study:
- To review and discuss advanced methods for risk prediction in DCM.
- To explore the potential of multiparametric risk assessment for predicting adverse outcomes in DCM.
Main Methods:
- Review of current literature on cardiac magnetic resonance imaging (CMR) and genetics in DCM risk prediction.
- Evaluation of biomarkers and cardiopulmonary exercise testing (CPET) for risk stratification in heart failure and DCM.
- Discussion of integrating these modalities for multiparametric risk assessment.
Main Results:
- Cardiac magnetic resonance imaging and genetic profiling offer promising avenues for improved risk prediction in DCM.
- Biomarkers and CPET are validated in broader heart failure populations but require specific evaluation in DCM.
- Multiparametric approaches integrating various data sources are likely to enhance risk stratification.
Conclusions:
- Novel imaging and genetic techniques show potential for refining DCM risk assessment.
- Further research is needed to validate and integrate biomarkers and CPET specifically for DCM.
- Developing parametric risk models combining multiple assessment methods is crucial for predicting sudden cardiac death and pump failure in DCM.
Abstract:
Dilated cardiomyopathy (DCM) is a common condition, which carries significant mortality from sudden cardiac death and pump failure. Left ventricular ejection fraction has conventionally been used as a risk marker for sudden cardiac death, but has performed poorly in trials. There have been significant advances in the areas of cardiac magnetic resonance imaging and genetics, which are able to provide useful rick prediction in DCM. Biomarkers and cardiopulmonary exercise testing are well validated in the prediction of risk in heart failure; however, they have been tested less specifically in the DCM setting. This review will discuss these methods with a view toward multiparametric risk assessment in DCM with the hope of creating parametric risk models to predict sudden cardiac death and pump failure in the DCM population.
