Key result
Advanced multimodality cardiac imaging improves sudden cardiac arrest prediction beyond traditional LVEF in heart failure.
Why the study?
Identifying heart failure patients at risk for sudden cardiac arrest remains challenging, and the role of LVEF has been debated as newer multimodality imaging techniques have emerged.
Do advanced multimodality cardiac imaging techniques improve the prediction of sudden cardiac arrest in patients with heart failure compared to traditional LVEF assessment?
Do advanced multimodality cardiac imaging techniques improve the prediction of sudden cardiac arrest in patients with heart failure compared to traditional LVEF assessment?
Advanced multimodality cardiac imaging techniques offer superior prognostic accuracy for predicting sudden cardiac arrest in heart failure patients compared to traditional LVEF assessment alone, potentially improving patient selection for ICD implantation.
Should not yet change ICD selection in HF; leaves open whether imaging refines SCA risk stratification in practice.
The identification of heart failure (HF) patients at risk for arrhythmic sudden cardiac arrest (SCA) is a major challenge in the cardiovascular field. In addition to optimal medical treatment for HF, implantable cardioverter defibrillator (ICD) is currently recommended to prevent SCA in patients with reduced left ventricular ejection fraction (LVEF). The indication for an ICD implantation, in addition to HF etiology, New York Health Association (NYHA) class and life expectancy, mainly depends on LVEF value at echocardiography. However, the actual role of LVEF in the prediction of SCA has recently been debated, while newer multimodality imaging techniques with increased prognostic accuracy have been developed. Speckle tracking imaging allows the quantification of mechanical dispersion, a marker of electrophysiological heterogeneity predisposing to malignant arrhythmias, while advanced cardiac magnetic resonance techniques such as myocardial T1-mapping and extracellular volume fraction assessment allow the evaluation of interstitial diffuse fibrosis. Nuclear imaging is helpful for the appraisal of sympathetic nervous system dysfunction, while newer computed tomography techniques assessing myocardial delayed enhancement allow the identification of focal myocardial scar. This review will focus on the most modern advances in the field of cardiovascular imaging along with its applications for the prediction of SCA in patients with HF. Modern artificial intelligence applications in cardiovascular imaging will also be discussed.
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Lio et al. (2023) conducted a review in Heart failure. Multimodality cardiac imaging vs. Left ventricular ejection fraction (LVEF) alone was evaluated. Advanced multimodality cardiac imaging techniques, such as speckle tracking echocardiography and cardiac magnetic resonance, improve the prediction of sudden cardiac arrest in patients with heart failure beyond traditional left ventricular ejection fraction assessment.
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