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Sudden Death Risk-Stratification in 2018-2019: The Old and the New

Sarah Zaman1, Jeffrey J Goldberger2, Pramesh Kovoor3

  • 1Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; MonashHEART, Monash Medical Centre, Melbourne, Vic, Australia.

Heart, Lung & Circulation
|November 29, 2018
PubMed

Insights

Sudden Cardiac Death (SCD) is a major concern. Current methods using left ventricular ejection fraction (LVEF) to guide implantable cardioverter-defibrillator (ICD) therapy are inadequate for preventing SCD.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Public Health

Background:

  • Sudden Cardiac Death (SCD) accounts for half of all cardiovascular deaths globally.
  • Implantable cardioverter-defibrillators (ICDs) are standard for SCD primary prevention in cardiomyopathy.
  • Left ventricular ejection fraction (LVEF) is widely used but inadequate for patient selection.

Purpose of the Study:

  • To evaluate the limitations of LVEF in predicting SCD risk.
  • To explore alternative predictors for identifying patients who would benefit from ICDs.
  • To address the challenge of accurate risk stratification for SCD prevention.

Main Methods:

  • Review of current literature on SCD predictors.
  • Analysis of the specificity and limitations of LVEF in patient selection for ICDs.
  • Identification of emerging biomarkers and diagnostic tools for arrhythmic risk assessment.

Main Results:

  • LVEF demonstrates poor specificity in distinguishing arrhythmic from non-arrhythmic death.
  • A significant proportion of sudden deaths occur in patients with preserved cardiac function (higher LVEF).
  • Electrophysiology studies, non-invasive electrical instability markers, myocardial fibrosis, and genetic/biomarkers show promise as alternate predictors.

Conclusions:

  • LVEF alone is insufficient for selecting patients for prophylactic ICD implantation.
  • New risk stratification strategies incorporating advanced markers are needed.
  • Accurate identification of high-SCD-risk patients with low competing non-sudden death risk is crucial for effective prevention.

Keywords:
CardiomyopathyImplantable cardioverter-defibrillatorPrimary preventionSudden cardiac death

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