Sudden Cardiac Death Prevention in Patients with Ischemic Heart Disease—Beyond the Ejection Fraction

TL;DR

This paper explores better ways to predict sudden cardiac death in heart disease patients beyond just using ejection fraction measurements.

Contribution

The paper reviews additional clinical parameters and tests that may improve prediction of sudden cardiac death beyond ejection fraction.

Findings

Many sudden cardiac death victims have normal ejection fractions.

ECG signs, biomarkers like sST2, and echocardiogram metrics may better predict risk.

Advanced tests like programmed ventricular stimulation and cardiac MRI show promise.

Abstract

Sudden cardiac death (SCD) in patients with ischemic heart disease remains a
leading cause of death. Prediction of who is at risk is based on the left
ventricular ejection fraction (EF). However, the majority of victims of SCD have
a normal EF, and the majority of patients implanted with an implantable
cardioverter- defibrillator based on their EF are never treated by their device.
Several parameters could allow better prediction of SCD. Several signs on the ECG
and Periodic Repolarization Dynamics have been associated with increased risk.
Elevated serum biomarkers such as pro-B type natriuretic peptides and serum
soluble suppression of tumorigenicity 2 protein (sST2) are predictive of SCD. On
the echocardiogram, global longitudinal strain, speckle tracking and relative
wall thickness have been implicated. Programmed ventricular stimulation studies
and cardiac magnetic resonance are promising modalities that could be further
investigated. In conclusion, the EF is an imperfect tool for predicting SCD.
Using the modalities reviewed, a model could be created for better prediction of
patients at risk.

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