Tamene Ashenafi, Tholakanahalli Venkatakrishna N, Chandrashekhar Y
Division of Cardiology, University of Minnesota and VA Medical Center, Minneapolis, MN 55417, USA.
Division of Cardiology, University of Minnesota and VA Medical Center, Minneapolis, MN 55417, USA; Professor of Medicine, University of Minnesota, Division of Cardiology (111c), 1, Veterans Drive, Minneapolis, MN 55417, USA.
Indian Heart J. 2014 Jan-Feb;66 Suppl 1(Suppl 1):S61-70. doi: 10.1016/j.ihj.2013.12.012. Epub 2014 Jan 12.
Identifying subjects who are at risk for SCD and stratifying them correctly into low or high-risk groups is the holy grail of Cardiology. While imaging shows a lot of promise, it is plagued by the fact that most SCD occurs in relatively healthy subjects, a massive group who would not ordinarily be subjected to imaging. Left ventricular ejection fraction (LVEF) currently is our primary parameter for risk stratification for sudden cardiac death but is a poor marker with low sensitivity and specificity. Current data shows that sophisticated imaging with techniques, mainly Cardiac magnetic resonance Imaging (CMR), have the potential to identify novel high-risk markers underlying SCD, beyond ejection fraction. Imaging seems to further refine risk in patients with low LVEF as well as in those with normal EF; this is a major strength of advanced imaging. Clinical application has been slow and not fully prime time. It is important to remember that while promising, imaging techniques including CMR, have not been tested in rigorous prospective studies and thus have not as yet replaced EF as the gatekeeper to ICD implantation.
识别有心脏性猝死（SCD）风险的个体并将他们正确地分为低风险或高风险组是心脏病学的圣杯。尽管成像显示出很大的前景，但它受到一个事实的困扰，即大多数SCD发生在相对健康的个体中，这是一个通常不会接受成像检查的庞大群体。左心室射血分数（LVEF）目前是我们对心源性猝死进行风险分层的主要参数，但它是一个较差的标志物，敏感性和特异性较低。目前的数据表明，主要采用心脏磁共振成像（CMR）等技术进行的精密成像有可能识别出除射血分数之外的、潜在的SCD新的高风险标志物。成像似乎能进一步细化低LVEF患者以及EF正常患者的风险；这是先进成像的一个主要优势。临床应用进展缓慢，尚未完全成熟。重要的是要记住，尽管成像技术（包括CMR）很有前景，但尚未在严格的前瞻性研究中得到检验，因此尚未取代EF作为植入式心脏复律除颤器（ICD）植入的守门指标。
