Key result
Multimodality imaging offers potential for sudden cardiac death risk stratification to overcome the low sensitivity and specificity of the current LVEF ≤35% approach.
Why the study?
Current ICD guidelines for primary prevention of SCD rely on an LVEF <=35%, which is limited by low sensitivity and specificity and has limited value across different etiologies.
Does multimodality imaging improve sudden cardiac death risk stratification compared to the standard LVEF-based approach?
Does multimodality imaging improve sudden cardiac death risk stratification compared to the standard LVEF-based approach?
Multimodality imaging offers a promising alternative to the limited LVEF ≤35% criterion for sudden cardiac death risk stratification, though prospective randomized data are needed.
May refine SCD stratification beyond LVEF; hypothesis-generating and requires prospective validation before practice change.
Sudden cardiac death (SCD) accounts for one fifth of global deaths, and occurs when a trigger (e.g. myocardial ischemia, premature ventricular contraction) interacts with an arrhythmic substrate (e.g. myocardial scar, dilated cardiomyopathy). Multimodality imaging (echocardiographic, cardiac magnetic resonance and nuclear techniques) can potentially visualize many predisposing substrates and triggers. Implantable cardioverter-defibrillator (ICD) is the most effective approach to primary prevention of SCD, and current guidelines regarding ICD implantation are based on a left ventricular ejection fraction (LVEF) ≤35%. This practice is limited by a low sensitivity and specificity, and has limited value when applied to different etiologies. In this review, the role of multimodality imaging in SCD risk-stratification and the limitations of an LVEF-based approach, are discussed. Additional randomized, prospective data are eagerly awaited to inform on the role of imaging in SCD risk-stratification, and ongoing/ planned trials are subsequently discussed.
No takes yet. Share an insight, caveat, or question.
Bijl et al. (2019) conducted a review in Sudden cardiac death. Multimodality imaging vs. LVEF-based approach was evaluated. Multimodality imaging offers potential for sudden cardiac death risk stratification to overcome the low sensitivity and specificity of the current LVEF ≤35% approach.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: