Assessing risk for ventricular tachyarrhythmias and sudden cardiac death: is there a role for cardiac MRI?
Assessing risk for ventricular tachyarrhythmias and sudden cardiac death: is there a role for cardiac MRI?
复制标题
评估室性快速心律失常和心源性猝死的风险：心脏 MRI 有作用吗？
DOI：
10.1161/circimaging.111.971135
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Wu,KatherineC
中科院分区：
文献类型：
--
作者：
Wu,KatherineC
Sudden cardiac death (SCD) is most commonly precipi-tated by malignant ventricular tachyarrhythmias and readily prevented by insertion of implantable cardioverterdefibrillators (ICDs). However, our ability to identify which individuals are at highest risk for SCD and thus candidates for ICDs remains inadequate. Current clinical guidelines for selecting patients who have yet to experience clinical evidence of sustained ventricular arrhythmias target those with reduced global left ventricular (LV) function (LV ejection fraction [LVEF] 30–35% with or without heart failure) as meeting criteria for primary prevention ICDs. 1 Patients who have survived a cardiac arrest episode, in the absence of a reversible cause, generally meet criteria for secondary prevention ICDs, as may individuals presenting with sustained ventricular tachyarrhythmias, particularly those with structural heart disease. 1 Using an LVEF threshold focuses on subpopulations with the highest incidence of SCD and originates from the results of previously published ICD and antiarrhythmic trials that preferentially included only these higher-risk cohorts. However, as was first noted by Myerburg et al2 in 1992, the highest absolute number of SCD events in the population as a whole occurs in patients without systolic LV dysfunction or established heart disease and few to no cardiac risk factors (see Figure 1; Zipes et al). 1 Hence, many patients who are at risk for SCD are not being identified as candidates for ICDs. This deficiency in risk stratification practice was articulated in a recent National Heart, Lung, and Blood Institute and Heart Rhythm Society workshop publication, which concluded that “Current methods of clinical risk prediction are inadequate and there is increasing recognition that employment of the LV ejection fraction as a risk predictor is effective in only a small subgroup of patients.” 3
