Pannone Luigi, Falasconi Giulio, Cianfanelli Lorenzo, Baldetti Luca, Moroni Francesco, Spoladore Roberto, Vergara Pasquale
Cardiology Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Arrhythmia Unit and Electrophysiology Laboratory, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
J Clin Med. 2021 Apr 22;10(9):1823. doi: 10.3390/jcm10091823.
Sudden cardiac death (SCD) is the leading cause of cardiovascular mortality in patients with coronary artery disease without severe systolic dysfunction and in heart failure with preserved ejection fraction. From a global health perspective, while risk may be lower, the absolute number of SCDs in patients with left ventricle ejection fraction >35% is higher than in those with severely reduced left ventricle ejection fraction (defined as ≤35%). Despite these observations and the high amount of available data, to date there are no clear recommendations to reduce the sudden cardiac death burden in the population with mid-range or preserved left ventricle ejection fraction. Ongoing improvements in risk stratification based on electrophysiological and imaging techniques point towards a more precise identification of patients who would benefit from ICD implantation, which is still an unmet need in this subset of patients. The aim of this review is to provide a state-of-the-art approach in sudden cardiac death risk stratification of patients with mid-range and preserved left ventricular ejection fraction and one of the following etiologies: ischemic cardiomyopathy, heart failure, atrial fibrillation or myocarditis.
心脏性猝死（SCD）是无严重收缩功能障碍的冠状动脉疾病患者以及射血分数保留的心力衰竭患者心血管死亡的主要原因。从全球健康角度来看，虽然风险可能较低，但左心室射血分数>35%的患者中SCD的绝对数量高于左心室射血分数严重降低（定义为≤35%）的患者。尽管有这些观察结果和大量可用数据，但迄今为止，尚无明确建议来减轻左心室射血分数中等或保留的人群中的心脏性猝死负担。基于电生理和成像技术的风险分层的不断改进，指向更精确地识别将从植入式心律转复除颤器（ICD）植入中获益的患者，这在这部分患者中仍是未满足的需求。本综述的目的是为左心室射血分数中等和保留且有以下病因之一的患者提供心脏性猝死风险分层的最新方法：缺血性心肌病、心力衰竭、心房颤动或心肌炎。
