Background

Heart failure with reduced ejection fraction is a common condition that has a poor prognosis. Accurate selection of patients with ischemic heart disease and idiopathic dilated cardiomyopathy, who are at risk of sudden cardiac death (SCD), remains a challenge. In these cases, current indications for implantable cardioverter-defibrillators (ICD) rely almost entirely on left ventricular ejection fraction. However, this parameter is insufficient. Recently, noninvasive imaging has provided insight into the mechanism underlying SCD using myocardial deformation on echocardiography and magnetic resonance imaging. The aim of this review article was to underline the emerging role of these novel parameters in identifying high-risk patients.

Methods

A literature search was carried out for reports published with the following terms: “sudden cardiac death,” “heart failure,” “noninvasive imaging,” “echocardiography,” “deformation,” “magnetic resonance imaging,” and “ventricular arrhythmia.” The search was restricted to reports published in English.

Results

The findings of this analysis suggest that cardiac magnetic resonance imaging and strain assessment by echocardiography, particularly longitudinal strain, can be promising techniques for cardiovascular risk stratification in patients with heart failure.

Conclusion

In future, risk stratification of arrhythmia and patient selection for ICD placement may rely on a multiparametric approach using combinations of imaging modalities in addition to left ventricular ejection fraction.

中文翻译：

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心力衰竭患者心源性猝死的风险分层

背景

射血分数降低的心力衰竭是一种预后不良的常见疾病。准确选择有心源性猝死 (SCD) 风险的缺血性心脏病和特发性扩张型心肌病患者仍然是一个挑战。在这些情况下，目前植入式心脏复律除颤器 (ICD) 的适应症几乎完全依赖于左心室射血分数。但是，这个参数是不够的。最近，通过超声心动图和磁共振成像的心肌变形，无创成像提供了对 SCD 潜在机制的深入了解。这篇综述文章的目的是强调这些新参数在识别高危患者中的新兴作用。

方法

对使用以下术语发表的报告进行了文献检索：“心源性猝死”、“心力衰竭”、“无创成像”、“超声心动图”、“变形”、“磁共振成像”和“室性心律失常”。搜索仅限于以英文发表的报告。

结果

该分析的结果表明，心脏磁共振成像和超声心动图应变评估，特别是纵向应变，可能是心力衰竭患者心血管风险分层的有前景的技术。

结论

未来，心律失常的风险分层和 ICD 放置的患者选择可能依赖于使用除左心室射血分数之外的成像方式组合的多参数方法。