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Peer-reviewedCC BYFrontiers in cardiovascular medicine

Risk stratification in early non-ischaemic cardiomyopathy: the interplay of genetics and cardiac imaging.

  • Alexandros Kasiakogias1
  • Christos Antoniou1
  • Theodoros Tsampras1
  • Freideriki-Eleni Kourti1
  • Athanasios Kordalis1
  • Alexios Antonopoulos1
  • Ioannis Leontsinis1
  • Charalambos Vlachopoulos1
  • Constantina Aggeli1
  • Konstantinos Tsioufis1
  1. 1First Department of Cardiology, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Abstract

Preventing sudden cardiac death (SCD) in early non-ischaemic cardiomyopathy (NICM) remains a major clinical challenge. Traditional risk stratification centred on left ventricular ejection fraction (LVEF) poorly captures arrhythmic risk, particularly in early dilated cardiomyopathy (DCM) and non-dilated left ventricular cardiomyopathy (NDLVC). Increasing recognition of fibrosis-based and genotype-specific arrhythmogenic substrates has prompted a shift towards multimodal risk assessment strategies integrating imaging, electrocardiographic, and genetic data. This review examines contemporary approaches to risk stratification in early NICM, with particular emphasis on the role of cardiovascular magnetic resonance (CMR) imaging and late gadolinium enhancement (LGE). The expanding role of genotype-specific phenotyping is also explored, including high-risk arrhythmogenic variants and the integration of genotype with imaging phenotype as a promising route to improved prediction. Collectively, these advances support a transition from population-based LVEF thresholds towards more personalised and biologically informed strategies for prevention of SCD in early NICM.

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Cite

BibTeXRIS
BibTeX
@article{kasiakogias2026risk,
  title = {{Risk stratification in early non-ischaemic cardiomyopathy: the interplay of genetics and cardiac imaging.}},
  author = {Alexandros Kasiakogias and Christos Antoniou and Theodoros Tsampras and Freideriki-Eleni Kourti and Athanasios Kordalis and Alexios Antonopoulos and Ioannis Leontsinis and Charalambos Vlachopoulos and Constantina Aggeli and Konstantinos Tsioufis},
  journal = {Frontiers in cardiovascular medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1890904},
  url = {https://europepmc.org/article/MED/42903411},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Risk stratification in early non-ischaemic cardiomyopathy: the interplay of genetics and cardiac imaging.
AU  - Alexandros Kasiakogias
AU  - Christos Antoniou
AU  - Theodoros Tsampras
AU  - Freideriki-Eleni Kourti
AU  - Athanasios Kordalis
AU  - Alexios Antonopoulos
AU  - Ioannis Leontsinis
AU  - Charalambos Vlachopoulos
AU  - Constantina Aggeli
AU  - Konstantinos Tsioufis
PY  - 2026
DA  - 2026/10/06
JO  - Frontiers in cardiovascular medicine
DO  - 10.3389/fcvm.2026.1890904
UR  - https://europepmc.org/article/MED/42903411
AB  - Preventing sudden cardiac death (SCD) in early non-ischaemic cardiomyopathy (NICM) remains a major clinical challenge. Traditional risk stratification centred on left ventricular ejection fraction (LVEF) poorly captures arrhythmic risk, particularly in early dilated cardiomyopathy (DCM) and non-dilated left ventricular cardiomyopathy (NDLVC). Increasing recognition of fibrosis-based and genotype-specific arrhythmogenic substrates has prompted a shift towards multimodal risk assessment strategies integrating imaging, electrocardiographic, and genetic data. This review examines contemporary approaches to risk stratification in early NICM, with particular emphasis on the role of cardiovascular magnetic resonance (CMR) imaging and late gadolinium enhancement (LGE). The expanding role of genotype-specific phenotyping is also explored, including high-risk arrhythmogenic variants and the integration of genotype with imaging phenotype as a promising route to improved prediction. Collectively, these advances support a transition from population-based LVEF thresholds towards more personalised and biologically informed strategies for prevention of SCD in early NICM.
SN  - 2297-055X
ER  -