Turakhia Mintu, Tseng Zian H
University of California, San Francisco, USA.
Curr Probl Cardiol. 2007 Sep;32(9):501-46. doi: 10.1016/j.cpcardiol.2007.05.002.
Sudden cardiac death is a major public health problem affecting 500,000 patients annually in the United States alone. The major risk factor for sudden cardiac death is the presence of coronary artery disease, usually in the setting of reduced ejection fraction. Globally, the incidence is expected to rise sharply as the prevalence of coronary artery disease and heart failure continue to increase. However, sudden cardiac death is a heterogeneous condition and may be caused by acute ischemia, structural defects, myocardial scar, and/or genetic mutations. Sudden death may occur even in a grossly normal heart. Beta-blockers can reduce the risk of sudden cardiac death, while implantable cardioverter defibrillators are effective at terminating malignant arrhythmias. Ejection fraction remains the major criterion to stratify patients for defibrillator implantation but this strategy alone is insensitive and nonspecific. Novel clinical, electrophysiologic, and genetic markers have been identified that may increase precision in patient selection for primary prevention therapy. This review discusses the epidemiology, mechanisms, etiologies, therapies, treatment guidelines, and future directions in the management of sudden cardiac death.
心脏性猝死是一个重大的公共卫生问题，仅在美国每年就影响50万患者。心脏性猝死的主要危险因素是存在冠状动脉疾病，通常是在射血分数降低的情况下。在全球范围内，随着冠状动脉疾病和心力衰竭的患病率持续上升，预计发病率将急剧上升。然而，心脏性猝死是一种异质性疾病，可能由急性缺血、结构缺陷、心肌瘢痕和/或基因突变引起。即使心脏大体正常，也可能发生猝死。β受体阻滞剂可降低心脏性猝死的风险，而植入式心律转复除颤器对终止恶性心律失常有效。射血分数仍然是对患者进行除颤器植入分层的主要标准，但仅这一策略不敏感且缺乏特异性。已确定了新的临床、电生理和基因标志物，这可能会提高一级预防治疗患者选择的精准度。本综述讨论了心脏性猝死管理中的流行病学、机制、病因、治疗、治疗指南及未来方向。
