Redefining Sudden Cardiac Death Risk Stratification in Dilated Cardiomyopathy: An Integrative Approach.

Dilated cardiomyopathy (DCM) is one of the most common cardiomyopathy phenotypes. Moreover, sudden cardiac death (SCD) remains a leading cause of mortality in patients with DCM, predominantly driven by malignant ventricular arrhythmias (VAs). Current guideline-recommended risk stratification relies heavily on left ventricular ejection fraction (LVEF) to guide implantable cardioverter-defibrillator (ICD) therapy; however, attention has recently shifted toward a multiparametric strategy that integrates clinical characteristics with electrocardiographic markers, biomarkers, cardiac magnetic resonance (CMR) findings, genetic testing, and electrophysiological studies. This review summarizes current evidence on established and emerging tools for SCD risk stratification in DCM, highlights the limitations of single-parameter approaches, and discusses future directions toward more personalized, dynamic risk assessment to optimize SCD outcomes.