Implantable Cardioverter-Defibrillator in Dilated Cardiomyopathy after the DANISH-Trial Lesson. A Poly-Parametric Risk Evaluation Is Needed to Improve the Selection of Patients

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  Figure 1. Potential reclassification of the risk of sudden cardiac death (SCD) by late gadolinium enhancement (LGE) fibrosis assessment combined with clinical and molecular genetic profiling, in patients with dilated cardiomyopathy (DCM) and heart failure (NYHA class II-III), under optimal medical therapy for at least 3 months, and with life expectancy >1 year. Among patients with severely depressed left ventricular function [ejection fraction (EF) ≤ 35%], a negative LGE test (absence of fibrosis) combined with the absence of familial DCM/SCD may identify a subgroup of patients at lower risk of SCD, in which implantable cardioverter-defibrillator (ICD) may be not necessary (blue). Among patients with moderately depressed left ventricular function (EF > 35% and ≤ 49%), a positive LGE test (presence of fibrosis) and/or the presence of familial DCM/SCD or pathological gene mutations may identify a subgroup at higher risk of SCD, in which ICD may be useful (green).