Identifying Patients at High Risk for Sudden Cardiac Death: Is Low Ejection Fraction Alone Enough, or Do We Need Additional Testing?

摘要

Sudden cardiac death (SCD) from ventricular tachycardia (VT) or ventricular fibrillation (VF) remains a major cause of mortality in the U.S. and Western Europe, and claims 2-3 lives per 100,000 per year [1, 2], The incidence of SCD has not declined in tandem with significant advances in the management of acute coronary syndromes, congestive heart failure (CHF) and cardiovascular disease in general, further highlighting the importance of identifying and treating patients at high risk for VT/VF.Reduced left ventricular ejection fraction (LVEF) has consistently been shown to predict first episodes of sustained VT or VF in patients with [3, 4] and without [5] coronary artery disease (CAD), recurrent VT or VF [6] and to predict the anti-arrhythmic benefits of revascularization [7].However, LVEF alone does not optimally predict VT or VF. Death due to VT or VF represents a smaller proportion of total mortality with progressive reductions in LVEF (in the Multicenter Unsustained Tachycardia Trial (MUSTT) among patients with CAD, unsustained VT and LVEF =< 40(percent) [3]) (Fig. 1), and with worsening CHF class [8].