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[(LV)EF is a poor predictor of sudden cardiac death : Pro/Contra]
Christian Butter1, Gerd Hindricks2
1Abteilung für Kardiologie, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Universitätsklinikum der Medizinischen Hochschule Brandenburg Theodor Fontane, Bernau, Deutschland. christian.butter@immanuelalbertinen.de.
Insights
Left ventricular ejection fraction (LVEF) has been uncritically used for sudden cardiac death risk stratification. Current guidelines require re-evaluation due to improved heart failure treatments and LVEF measurement limitations.
Area of Science:
- Cardiology
- Medical Diagnostics
Context:
- Left ventricular ejection fraction (LVEF) has been a cornerstone in risk stratifying patients with ischemic and non-ischemic cardiomyopathy for over two decades.
- Historically, LVEF has been used to identify individuals at risk of sudden cardiac death.
Purpose:
- To critically re-evaluate the role of LVEF in risk stratification for sudden cardiac death.
- To assess the continued validity of LVEF cut-off values in current clinical guidelines.
Summary:
- The study questions the long-standing, uncritical reliance on LVEF for risk stratification.
- It highlights that LVEF cut-off values in guidelines are close to echocardiography's measurement accuracy.
- The effectiveness of implantable cardioverter defibrillators (ICDs) in high-risk patients needs re-evaluation given advancements in heart failure management.
Impact:
- This re-evaluation is crucial for optimizing patient selection for ICDs.
- It emphasizes the need to consider evolving interventional and pharmaceutical treatments for heart failure.
- The findings may lead to revised guidelines for cardiac risk assessment and management.
Abstract:
For more than two decades the left ventricular ejection fraction (LVEF) has been utilized with practically uncritical absolutism for the risk stratification of patients with ischemic and, historically, also nonischemic cardiomyopathy, in order to identify patients who could be threatened by sudden cardiac death. Based on historical data and in the absence of other better predictive parameters, the LVEF continues to appear in the guidelines unchanged, with cut-off values that lie in the region of the measurement accuracy of LVEF as determined by echocardiography. The basic identification of high-risk patients who then really benefit from an implantable cardioverter defibrillator (ICD) must be re-evaluated under the aspect of a meaningfully altered interventional and pharmaceutical treatment of heart failure.
