Beyond Ejection Fraction: Novel Clinical Approaches Towards SuddenCardiac Death Risk Stratification in Patients with Dilated Cardiomyopathy

Figures

• 

  Fig. (1). Cardiac magnetic resonance frames showing normal ejection fraction in A and B) 4-chamber end-diastole and end-systole, C and D) 2-chamber end-diastole and end-systole, and E and F) 3-chamber end-diastole and end-systole.

• 

  Fig. (2). Cardiac magnetic resonance imaging of the left ventricular wall with late gadolinium enhancement demonstrating fibrosis in a short axis view. In ascending order from A to F. Fibrosis can be seen in inferior, inferoseptal, and inferolateral walls.

• 

  Fig. (3). End diastolic and end-systolic 4-chamber views of a heart with a normal ejection fraction with a large amount of fibrosis.

• 

  Fig. (4). Strain pattern on echocardiography in a patient with normal ejection fraction. Strain <-18% is normal (A higher resolution / colour version of this figure is available in the electronic copy of the article).

• 

  Fig. (5). Proposed flowchart evaluation for the need of an ICD in patients with an ejection fraction less than 35% and 35% to 50%. NICM: non-ischemic cardiomyopathy. GDMT: guideline-directed medical therapy. LVEF: left ventricular ejection fraction. NYHA: New York Heart Association. ICD: Implantable cardioverter-defibrillator. LGE: late gadolinium enhancement. LAS: long-axis strain. CMR: cardiac magnetic resonance imaging. WCD: wearable cardioverter-defibrillator.

• 

  Fig. (6). Electrophysiologic parameters used in risk assessment of patients for SCD, based on Goldberger et al. (81). Baroreflex Sensitivity (BRS), Electrophysiology Study (EPS), Heart Rate Turbulence (HRT), Heart Rate Variability (HRV), Left Ventricular End-diastolic Dimension (LVEDD), Left Ventricular Ejection Fraction (LVEF), Nonsustained Ventricular Tachycardia (NSVT), QRS duration, fragmented QRS, QRS-T angle, Signal-averaged Electrocardiogram (SAECG), Left Bundle Branch Block (LBBB), and T-Wave Alternans (TWA) (A higher resolution / colour version of this figure is available in the electronic copy of the article).