Imaging for sudden cardiac death risk stratification: Current perspective and future directions

Area of Science:

• Cardiology
• Medical Imaging
• Preventive Medicine

Background:

• Sudden cardiac death (SCD) accounts for 20% of global deaths.
• It results from triggers interacting with arrhythmic substrates.
• Current prevention strategies rely on left ventricular ejection fraction (LVEF) ≤35%, which has limitations.

Purpose of the Study:

• To review the role of multimodality imaging in sudden cardiac death risk-stratification.
• To discuss the limitations of the current LVEF-based approach for SCD prevention.

Main Methods:

• Review of existing literature on multimodality imaging techniques (echocardiography, cardiac MRI, nuclear imaging).
• Analysis of current guidelines for implantable cardioverter-defibrillator (ICD) implantation.
• Discussion of the diagnostic capabilities of imaging for SCD substrates and triggers.

Main Results:

• Multimodality imaging can visualize substrates and triggers predisposing to SCD.
• The current LVEF-based approach for ICD implantation shows low sensitivity and specificity.
• Imaging offers potential for more accurate SCD risk stratification across diverse etiologies.

Conclusions:

• Multimodality imaging holds promise for refining SCD risk stratification beyond LVEF.
• Further randomized, prospective data are needed to establish imaging's role in guiding SCD prevention.
• Ongoing and planned trials will provide crucial insights into imaging-guided SCD risk management.