LAUSR

215 HF patients is their younger age, smaller number of comorbidities, and a different clinical course of the disease, including a higher likelihood of beneficial left ventricular reverse remodeling. Precise evaluation of risks in DCM patients is of utmost importance, so that appropriate life counselling can be provided (eg, family plan‐ ning, career guidance), treatment can be guid‐ ed reliably (eg, step ‐up or step ‐down; ICD rec‐ ommendations, appropriate timing of heart transplantation) and the clinical course of the disease can be predicted. In the upcoming era of tailored medicine, the evaluation of disease ‐ ‐inherent risks is not merely an academic issue but the cornerstone of individualized manage‐ ment. Hence, modern cardiology is at the fore‐ front of scale ‐dedicated research, and there are now many validated and newly ‐published scales, including a score evaluatingthromboembolic risk in AF.4 Although the number of HF scales is consid‐ erable, they are all based on general HF cohorts, consisting mostly of patients with ischemic HF. Consequently, their application in DCM is some‐ what questionable. Surprisingly, there is still no scale applicable specifically to DCM. Therefore, to respond to this yet unmet clinical need, we developed a scale based on a fairly large DCM population. Briefly, we analyzed the records of 406 DCM patients during 48.2 months of follow ‐up.5 Initially, we examined 8 most pop‐ ular HF prognostic scales in DCM and found that all of them overestimated the true mortal‐ ity risks. Next, we built a unique linear model based on 21 parameters, including clinical, elec‐ trocardiographic, echocardiographic, and labo‐ ratory parameters, as well as the applied treat‐ ment. This newly ‐developed Krakow DCM Risk Score (Krakow ‐DCM) provided the best accu‐ racy and discriminative power in comparison with all other HF models. Although the number of required parameters is relatively large, all of them are readily available in DCM patients. Fur‐ thermore, the Krakow ‐DCM model supplies the To the editor We read with great interest the recent paper by Kucharz and Kułakowski1 pub‐ lished in the November 2020 issue of Kardio‐ logia Polska (Kardiol Pol, Polish Heart Journal), in which the authors raised the important is‐ sue of arrhythmic events (AEs) occurrence and implantable cardioverter ‐defibrillator (ICD) in‐ terventions in patients with heart failure (HF). The finding regarding the predictive role of frag‐ mented QRS (fQRS) in AE gives rise to a much ‐ ‐needed discussion on the novel management of ICD implantation. Given the lack of any clear benefits stemming from ICD implantation in unselected patients with dilated cardiomyop‐ athy (DCM), as shown in the previous studies, and the significant association between appro‐ priate ICD interventions and ischemic etiology of HF reported by Winkler et al2, we would like to give some consideration to the significant predictors of AE in DCM, especially due to the fact that in the analysis presented by Kucharz and Kułakowski,1 DCM patients constituted a quarter of the study population. Notably, none of the HF guidelines differen‐ tiate the management strategies based on eti‐ ology, whereas a growing body of evidence sug‐ gests potentially different levels of risk for AE and nonhomogenous benefits arising from pro‐ phylactic ICD implantations in HF. These obser‐ vations are particularly relevant in the context of the novel therapy with angiotensin receptor neprilysin inhibitors, which reduces the risk for AE.3 Therefore, novel predictors of AE and ap‐ propriate ICD shocks are eagerly awaited and much sought ‐after in HF and DCM. Bearing in mind the recent important discovery of Kucharz and Kułakowski regarding the predictive role of fQRS in determination of AE risk in the gener‐ al HF cohort, we are wondering whether there is any relationship between fQRS and HF etiol‐ ogy (ie, ischemic vs nonischemic HF). As is well ‐known, nearly 1 in 5 patients with HF and reduced ejection fraction has DCM. What makes DCM patients different from other L E T T E R T O T H E E D I T O R