van der Bijl Pieter, Delgado Victoria, Bax Jeroen J
Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands.
Trends Cardiovasc Med. 2016 May;26(4):348-60. doi: 10.1016/j.tcm.2015.10.003. Epub 2015 Oct 17.
Sudden cardiac death (SCD) accounts for approximately 15-20% of all deaths worldwide. While the majority of SCDs occur in adults, children, and adults <35 years (<1%) may also be affected. Currently the most effective strategy for both primary and secondary prevention of SCD is the implantable cardioverter-defibrillator (ICD). However, identification of patients who will benefit from ICD implantation remains challenging. Left ventricular ejection fraction (LVEF) is the most frequent imaging parameter used to select patients for ICD implantation for primary prevention. However, LVEF has shown to be suboptimal for prediction of benefit. Non-invasive cardiac imaging permits characterization of the arrhythmogenic substrate, including dispersion of electromechanical activation, presence of myocardial scar, and cardiac innervation status. The arrhythmogenic substrate may change across the different underlying diseases. While in ischemic cardiomyopathy, differentiation and characterization of infarct core and peri-infarct zone have been shown to refine the risk stratification of patients, in non-ischemic cardiomyopathies, the substrate may be more heterogeneous and tissue characterization assessing focal and diffuse fibrosis and inflammation processes may be more relevant. Furthermore, in channelopathies, assessment of mechanical dispersion between myocardial layers may identify the patients with increased risk of ventricular arrhythmias. Finally, potential triggers of ventricular arrhythmias such as myocardial ischemia can be evaluated. The role of noninvasive imaging in the risk stratification of SCD and the selection of candidates for ICD will be discussed in this article.
心脏性猝死（SCD）约占全球所有死亡人数的15%-20%。虽然大多数心脏性猝死发生在成年人中，但儿童以及年龄小于35岁的成年人（<1%）也可能受到影响。目前，心脏性猝死一级和二级预防最有效的策略是植入式心脏复律除颤器（ICD）。然而，识别哪些患者将从ICD植入中获益仍然具有挑战性。左心室射血分数（LVEF）是用于选择适合一级预防ICD植入患者的最常用影像学参数。然而，LVEF已被证明在预测获益方面并不理想。非侵入性心脏成像能够对致心律失常基质进行特征描述，包括机电激活的离散度、心肌瘢痕的存在以及心脏神经支配状态。致心律失常基质可能因不同的潜在疾病而有所变化。在缺血性心肌病中，梗死核心和梗死周边区域的区分和特征描述已被证明可优化患者的风险分层，而在非缺血性心肌病中，基质可能更加异质性，评估局灶性和弥漫性纤维化及炎症过程的组织特征描述可能更具相关性。此外，在离子通道病中，评估心肌层之间的机械离散度可能识别出室性心律失常风险增加的患者。最后，还可以评估室性心律失常的潜在触发因素，如心肌缺血。本文将讨论非侵入性成像在心脏性猝死风险分层和ICD候选者选择中的作用。
