Prevention of sudden cardiac death in ischaemic cardiomyopathy

ESC CardioMed ◽  
2018 ◽  
pp. 2333-2337
Author(s):  
Jorge Romero ◽  
Andrea Natale ◽  
Ricardo Avendano ◽  
Mario Garcia ◽  
Luigi Di Biase
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Risk Stratification ◽  
Cardiac Death ◽  
Electrophysiological Study ◽  
Total Mortality ◽  
Ischaemic Cardiomyopathy ◽  
Cmr Imaging

Sudden cardiac death (SCD) is a major health problem in both the United States and worldwide. There is considerable controversy regarding the optimal time after acute myocardial infarction for risk stratification as well as the ideal time to place an implantable cardioverter defibrillator for primary prevention for SCD. Several parameters have been considered and tested for risk stratification of SCD after acute myocardial infarction. However, the only criterion that is currently being implemented is the left ventricular ejection fraction (LVEF). There are different imaging methods to measure LVEF, including echocardiography, cardiovascular magnetic resonance (CMR) imaging, nuclear scintigraphy, and angiography. When compared, these methods have shown modest correlation among them with up to 10% differences in LVEF and wide standard deviations (average 10%), which raises questions about their reliability to make decisions about primary prevention strategies for these patients. Moreover, LVEF assessment after acute myocardial infarction may be significantly affected by transient myocardial stunning and patients with a LVEF greater than 35% are not exempt from ventricular arrhythmias. Despite previous studies showing a considerably higher reduction in cardiac and total mortality when electrophysiological study is performed, current guidelines for prevention of SCD do not recommend electrophysiological study very strongly. CMR imaging has gained popularity for risk stratification of SCD. Delayed gadolinium enhancement has been proven to be useful in the identification of myocardial scar due to acute or chronic myocardial infarction. In the authors’ opinion, electrophysiological study and CMR imaging and probably strain echocardiography as well as cardiac iodine-123 metaiodobenzylguanidine will eventually play more important roles in risk stratification of patients with ischaemic cardiomyopathy based on the data published to date.

Unique Strategy of Early Risk Stratification for the Primary Prevention of Sudden Cardiac Death Post-myocardial Infarction

2009 ◽  
Vol 18 ◽  
pp. S146-S147
Author(s):  
Saurabh Kumar ◽  
Sarah Zaman ◽  
Gopal Sivagangabalan ◽  
Vicki Eipper ◽  
Arun Narayan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Risk Stratification ◽  
Cardiac Death ◽  
Post Myocardial Infarction ◽  
Early Risk

Management of Cardiovascular Disease in Dialysis Patients

2017 ◽  
Author(s):  
John K. Roberts ◽  
John P. Middleton
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Volume Overload ◽  
Current Evidence ◽  
Dialysis Patients ◽  
Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes. 

Management of Cardiovascular Disease in Dialysis Patients

2017 ◽  
Author(s):  
John K. Roberts ◽  
John P. Middleton
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Volume Overload ◽  
Current Evidence ◽  
Dialysis Patients ◽  
Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes. 

Beyond ejection fraction: Novel clinical approaches towards sudden cardiac death risk stratification in patients with dilated cardiomyopathy

2021 ◽  
Vol 17 ◽  
Author(s):  
Issa Pour-Ghaz ◽  
Mark Heckle ◽  
Ikechukwu Ifedili ◽  
Sharif Kayali ◽  
Christopher Nance ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Cardiac Death ◽  
Ventricular Tachyarrhythmia ◽  
Total Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Icd Therapy

: Implantable cardioverter-defibrillator (ICD) therapy is indicated for patients at risk for sudden cardiac death due to ventricular tachyarrhythmia. The most commonly used risk stratification algorithms use left ventricular ejection fraction (LVEF) to determine which patients qualify for ICD therapy, even though LVEF is a better marker of total mortality than ventricular tachyarrhythmias mortality. This review evaluates imaging tools and novel biomarkers proposed for better risk stratifying arrhythmic substrate, thereby identifying optimal ICD therapy candidates.

Sign in / Sign up

Export Citation Format

Share Document