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Published on: December 19, 2013
Multimodality imaging predictors of sudden cardiac death
Fancesco Bandera1,2, Lilit Baghdasaryan3, Giulia Elena Mandoli4
1Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
Insights
Sudden cardiac death risk in cardiomyopathies can be better identified using advanced imaging techniques beyond ejection fraction. These methods, focusing on scar detection, improve patient selection for interventions.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiac Electrophysiology
Background:
- Sudden cardiac death (SCD) is a critical event in cardiomyopathies.
- Current guidelines rely solely on left ventricular ejection fraction (LVEF) for implantable cardioverter-defibrillator (ICD) selection, leaving many high-risk patients undertreated.
Purpose of the Study:
- To review advanced imaging modalities for SCD risk stratification in cardiomyopathies.
- To explore the role of tissue characterization, particularly scar detection, in identifying high-risk individuals.
Main Methods:
- Review of evidence for advanced echocardiography, cardiac magnetic resonance (CMR), and nuclear cardiology.
- Focus on modalities aiding in tissue characterization and scar identification.
Main Results:
- Advanced imaging offers more sensitive and specific markers for SCD risk than LVEF alone.
- Scar detection via these modalities is crucial for understanding arrhythmia pathogenesis.
Conclusions:
- Integrating advanced echocardiography, CMR, and nuclear cardiology can refine SCD risk stratification in cardiomyopathies.
- These techniques address limitations of current guidelines, improving patient selection in ambiguous cases.
Abstract:
Sudden cardiac death (SCD) is the worst clinical event occurring in the clinical context of cardiomyopathies. Current guidelines recommend using LV ejection fraction as the only imaging-derived parameter to identify patients who may benefit from ICD implantation in cardiomyopathies with reduced ejection fraction; however, a relevant proportion of high-risk population is left with unmet therapeutic goal. In case of dilated, hypertrophic, or arrhythmogenic cardiomyopathies, there is still a room for more sensitive and specific risk markers for identifying a cluster at higher risk of SCD. In this paper, we reviewed the evidence supporting the use of advanced echocardiography, CMR, and nuclear cardiology for SCD stratification in patients with the most common cardiomyopathies. The added value of these modalities may be explained on the basis of tissue characterization, especially scar detection, a central player in the pathogenesis of arrhythmias. Therefore, integration of these modalities to our everyday clinical practice may help in dealing with the gray zones where current guidelines are still ineffective for patient selection.
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