Sudden cardiac death risk stratification.
Sudden cardiac death risk stratification.
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DOI：
10.1161/circresaha.116.304493
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发表时间：
2015-06-05
影响因子：
20.1
通讯作者：
Goldberger JJ
中科院分区：
文献类型：
--
作者：
Deyell MW;Krahn AD;Goldberger JJ
心律失常性心脏性猝死 (SCD) 可能是由于室性心动过速/颤动 (SCD-VT/VF) 或无脉性电活动/心脏停搏所致。有效的风险分层来识别有心律失常性 SCD 风险的患者对于确定我们的医疗保健和研究资源来解决这一重要的公共卫生问题至关重要。尽管我们对无脉电活动/心搏停止引起的 SCD 的了解不断加深，但绝大多数风险分层研究都集中在 SCD-VT/VF。本综述重点关注 SCD-VT/VF 的现有和新型风险分层工具。对于患有左心室功能障碍和/或心肌梗死的患者，影像学、心脏自主功能测量和复极测量的进步在改善风险方面显示出了巨大的希望。然而，大多数 SCD-VT/VF 发生在没有已知心脏病的患者中。除了传统的仅针对冠状动脉疾病的风险分层之外，生物标志物和新颖的成像技术可以为普通人群提供进一步的风险分层。尽管取得了这些进展，但在对 SCD 产生有意义的影响之前，风险分层仍然存在重大挑战，必须克服这些挑战。
Arrhythmic sudden cardiac death (SCD) may be due to ventricular tachycardia/fibrillation (SCD-VT/VF) or pulseless electrical activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our health care and research resources to tackle this important public health issue. Although our understanding of SCD due to pulseless electrical activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-VT/VF. This review focuses on existing and novel risk stratification tools for SCD-VT/VF. For patients with left ventricular dysfunction and/or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining risk. Yet the majority of SCD-VT/VF occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further risk stratification in the general population beyond traditional risk stratification for coronary artery disease alone. Despite these advances, significant challenges in risk stratification remain that must be overcome before a meaningful impact on SCD can be realized.