Key result
Left ventricular ejection fraction is an imperfect tool for predicting sudden cardiac death in ischemic heart disease, and combining it with novel modalities like ECG markers, biomarkers, and advanced imaging may improve risk stratification.
Why the study?
Left ventricular ejection fraction is an imperfect tool for predicting sudden cardiac death in ischemic heart disease, as most victims have a normal ejection fraction and many implanted devices are never utilized.
Does the use of novel risk stratification modalities beyond LVEF improve the prediction of sudden cardiac death in patients with ischemic heart disease?
Does the use of novel risk stratification modalities beyond LVEF improve the prediction of sudden cardiac death in patients with ischemic heart disease?
Relying solely on LVEF to predict sudden cardiac death in ischemic heart disease misses many at-risk patients, highlighting the need for multiparametric risk models incorporating ECG, biomarkers, and advanced imaging.
Answers are grounded in this paper and cite their sources.
May refine SCD risk stratification beyond EF; leaves open whether ECG markers or PRD alter ICD decisions in prospective trials.
Sudden cardiac death (SCD) in patients with ischemic heart disease remains a leading cause of death. Prediction of who is at risk is based on the left ventricular ejection fraction (EF). However, the majority of victims of SCD have a normal EF, and the majority of patients implanted with an implantable cardioverter- defibrillator based on their EF are never treated by their device. Several parameters could allow better prediction of SCD. Several signs on the ECG and Periodic Repolarization Dynamics have been associated with increased risk. Elevated serum biomarkers such as pro-B type natriuretic peptides and serum soluble suppression of tumorigenicity 2 protein (sST2) are predictive of SCD. On the echocardiogram, global longitudinal strain, speckle tracking and relative wall thickness have been implicated. Programmed ventricular stimulation studies and cardiac magnetic resonance are promising modalities that could be further investigated. In conclusion, the EF is an imperfect tool for predicting SCD. Using the modalities reviewed, a model could be created for better prediction of patients at risk.
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Steiner et al. (2022) conducted a review in Ischemic heart disease. Risk stratification modalities beyond ejection fraction was evaluated. Left ventricular ejection fraction is an imperfect tool for predicting sudden cardiac death in ischemic heart disease, and combining it with novel modalities like ECG markers, biomarkers, and advanced imaging may improve risk stratification.
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