Review on Non-Invasive Risk Stratification of Sudden Cardiac Death

AbstractIn relatives of index patients with dilated cardiomyopathy and arrhythmogenic cardiomyopathy, early detection of disease onset is essential to prevent sudden cardiac death and facilitate early treatment of heart failure. However, the optimal screening interval and combination of diagnostic techniques are unknown. The clinical course of disease in index patients and their relatives is variable due to incomplete and age-dependent penetrance. Several biomarkers, electrocardiographic and imaging (echocardiographic deformation imaging and cardiac magnetic resonance imaging) techniques are promising non-invasive methods for detection of subclinical cardiomyopathy. However, these techniques need optimisation and integration into clinical practice. Furthermore, determining the optimal interval and intensity of cascade screening may require a personalised approach. To address this, the CVON-eDETECT (early detection of disease in cardiomyopathy mutation carriers) consortium aims to integrate electronic health record data from long-term follow-up, diagnostic data sets, tissue and plasma samples in a multidisciplinary biobank environment to provide personalised risk stratification for heart failure and sudden cardiac death. Adequate risk stratification may lead to personalised screening, treatment and optimal timing of implantable cardioverter defibrillator implantation. In this article, we describe non-invasive diagnostic techniques used for detection of subclinical disease in relatives of index patients with dilated cardiomyopathy and arrhythmogenic cardiomyopathy.

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Non invasive of risk stratification sudden cardiac death

EP Europace ◽

10.1093/europace/eur216 ◽

2011 ◽

Vol 13 (Supplement 3) ◽

pp. NP-NP

Author(s):

E. Watanabe ◽

Y. Sobue ◽

M. Osaka ◽

Y. Ozaki ◽

I. Kodama ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Risk Stratification ◽

Cardiac Death ◽

Non Invasive

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Long-term Non-Invasive ECG-based Risk Stratification of Sudden Cardiac Death: Extended 5-year Results

International Cardiovascular Forum Journal ◽

10.17987/icfj.v11i0.393 ◽

2017 ◽

Vol 11 ◽

Author(s):

Elena Okisheva ◽

Dmitry Tsaregorodtsev ◽

Vitaly Sulimov

Keyword(s):

Sudden Cardiac Death ◽

Risk Stratification ◽

Predictive Value ◽

Cardiac Death ◽

Ecg Monitoring ◽

Non Invasive ◽

Increased Risk ◽

All Cause Mortality ◽

High Negative Predictive Value

Objectives: To evaluate predictive value of heart rate turbulence (HRT), deceleration capacity (DC) and microvolt T-wave alternans (mTWA) for risk stratification for sudden cardiac death (SCD) in patients after myocardial infarction (MI) during 60 months of follow-up.Methods: We studied 111 patients after MI occurred > 60 days (27 [9; 84] months) before enrollment (84 men; mean age 64.1±10.5 years). All subjects had 24-hour ambulatory ECG monitoring with HRT, DC and mTWA evaluation. Follow-up period was 60 months; primary endpoint was SCD, secondary endpoint included all non-sudden cardiovascular deaths.Results: During follow-up, we registered 19 cases of SCD and 11 cases of non-sudden cardiovascular deaths (including 7 fatal MI and 3 fatal strokes). DC had high negative predictive value (97.4% for all-cause mortality and 93.7% for SCD). DC values below 4.15 for all-cause mortality and 2.0 for SCD significantly increased risk of all-cause mortality (OR 8.5, 95% CI 2.9 to 24.6, р<0.001) и SCD (OR 9.6, 95% CI 3.2 to 28.5, р<0.001). Combined risk assessment at 12 months revealed that the most significant combination was HRT2 and mTWA100 > 53 mcV, which increased risk both of all-cause mortality (30.7-fold) and SCD (63.3-fold); however, at 60 months this predictive value for SCD decreased (OR = 20.8 (95% CI 2.8 to 114.0), p <0.001).Conclusion: Evaluation of HRT, DC and mTWA during 24-hour ECG monitoring may define the high risk of cardiovascular mortality and SCD in post-MI patients especially during the first 12 months after the baseline examination.

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Non-invasive risk stratification for sudden cardiac death by heart rate turbulence and microvolt T-wave alternans in patients after myocardial infarction

EP Europace ◽

10.1093/europace/eus238 ◽

2012 ◽

Vol 14 (12) ◽

pp. 1786-1792 ◽

Cited By ~ 13

Author(s):

V. Sulimov ◽

E. Okisheva ◽

D. Tsaregorodtsev

Keyword(s):

Myocardial Infarction ◽

Heart Rate ◽

Sudden Cardiac Death ◽

Risk Stratification ◽

Cardiac Death ◽

Heart Rate Turbulence ◽

Non Invasive ◽

T Wave ◽

T Wave Alternans

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Prognostic implications of troponin T variations in inherited cardiomyopathies using systems biology

npj Genomic Medicine ◽

10.1038/s41525-021-00204-w ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Rameen Shakur ◽

Juan Pablo Ochoa ◽

Alan J. Robinson ◽

Abhishek Niroula ◽

Aneesh Chandran ◽

...

Keyword(s):

Heart Failure ◽

Systems Biology ◽

Sudden Cardiac Death ◽

Risk Stratification ◽

Clinical Data ◽

Cardiac Death ◽

Troponin T ◽

Management Options ◽

Familial Cardiomyopathy ◽

The Impact

AbstractThe cardiac troponin T variations have often been used as an example of the application of clinical genotyping for prognostication and risk stratification measures for the management of patients with a family history of sudden cardiac death or familial cardiomyopathy. Given the disparity in patient outcomes and therapy options, we investigated the impact of variations on the intermolecular interactions across the thin filament complex as an example of an unbiased systems biology method to better define clinical prognosis to aid future management options. We present a novel unbiased dynamic model to define and analyse the functional, structural and physico-chemical consequences of genetic variations among the troponins. This was subsequently integrated with clinical data from accessible global multi-centre systematic reviews of familial cardiomyopathy cases from 106 articles of the literature: 136 disease-causing variations pertaining to 981 global clinical cases. Troponin T variations showed distinct pathogenic hotspots for dilated and hypertrophic cardiomyopathies; considering the causes of cardiovascular death separately, there was a worse survival in terms of sudden cardiac death for patients with a variation at regions 90–129 and 130–179 when compared to amino acids 1–89 and 200–288. Our data support variations among 90–130 as being a hotspot for sudden cardiac death and the region 131–179 for heart failure death/transplantation outcomes wherein the most common phenotype was dilated cardiomyopathy. Survival analysis into regions of high risk (regions 90–129 and 130–180) and low risk (regions 1–89 and 200–288) was significant for sudden cardiac death (p = 0.011) and for heart failure death/transplant (p = 0.028). Our integrative genomic, structural, model from genotype to clinical data integration has implications for enhancing clinical genomics methodologies to improve risk stratification.

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Sudden Cardiac Death in Hereditary Dilated Cardiomyopathy

Sudden Cardiac Death ◽

10.5772/intechopen.91702 ◽

2020 ◽

Author(s):

Marianna Leopoulou ◽

Jo Ann LeQuang ◽

Joseph V. Pergolizzi ◽

Peter Magnusson

Keyword(s):

Sudden Cardiac Death ◽

Left Ventricle ◽

Sudden Death ◽

Risk Stratification ◽

Dilated Cardiomyopathy ◽

Cardiac Death ◽

Disease Risk ◽

Systolic Dysfunction ◽

Preventive Strategies ◽

Genetic Origin

Dilated cardiomyopathy (DCM) is characterized by the phenotype of a dilated left ventricle with systolic dysfunction. It is classified as hereditary when it is deemed of genetic origin; more than 50 genes are reported to be related to the condition. Symptoms include, among others, dyspnea, fatigue, arrhythmias, and syncope. Unfortunately, sudden cardiac death may be the first manifestation of the disease. Risk stratification regarding sudden death in hereditary DCM as well as preventive management poses a challenge due to the heterogeneity of the disease. The purpose of this chapter is to present the epidemiology, risk stratification, and preventive strategies of sudden cardiac death in hereditary DCM.

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