State University of New York, Downstate Medical Center and New York Harbor VA Healthcare System, Brooklyn, NY 11209, USA.
Cardiol J. 2010;17(1):4-10.
Management of sudden cardiac death (SCD) is undergoing radical change in direction. It is becoming increasingly appreciated that besides depressed left ventricular systolic function and the conventional risk stratification tools, new markers for plaque vulnerability, enhanced thrombogenesis, specific genetic alterations of the autonomic nervous system, cardiac sarcolemmal and contractile proteins, and familial clustering may better segregate patients with atherosclerotic coronary artery disease (CAD) who are at high risk of SCD from those who may suffer from nonfatal ischemic events. Better understanding of pathophysiologic processes such as post-myocardial infarction remodeling, the transition from compensated hypertrophy to heart failure, and the increased cardiovascular risk of CAD in the presence of diabetes or even a pre-diabetic state will help to improve both risk stratification and management. The rapidly developing fields of microchips technology, and proteomics may allow rapid and cost-effective mass screening of multiple risk factors for SCD. The ultimate goal is not only to change the current direction of management strategy of SCD away from increased ICD utilization, but to identify novel methods for risk stratification, risk modification, and prevention of SCD that could be applied to the general public at large.
心脏性猝死（SCD）的管理正在发生根本性的变化。人们越来越认识到，除了左心室收缩功能降低和传统的危险分层工具外，斑块易损性、血栓形成增强、自主神经系统、心肌肌膜和收缩蛋白的特定遗传改变以及家族聚集的新标志物可以更好地区分患有动脉粥样硬化性冠状动脉疾病（CAD）的患者SCD 的高风险患者与那些可能患有非致命性缺血事件的患者。更好地了解心肌梗死后重构、从代偿性肥厚到心力衰竭的转变以及糖尿病甚至糖尿病前期状态下 CAD 心血管风险增加等病理生理过程，将有助于改善危险分层和管理。微芯片技术和蛋白质组学等快速发展的领域可能允许快速、经济有效地对 SCD 的多个危险因素进行大规模筛查。最终目标不仅是改变 SCD 管理策略的当前方向，使其远离增加 ICD 的应用，而且要确定用于 SCD 的危险分层、危险修正和预防的新方法，可以将其应用于广大公众。
