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Risk stratification for sudden cardiac death in patients with heart failure

Emerging role of imaging parameters

Risikostratifizierung für den plötzlichen Herztod bei Patienten mit Herzinsuffizienz

Zunehmende Bedeutung von Bildgebungsparametern

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Abstract

Background

Heart failure with reduced ejection fraction is a common condition that has a poor prognosis. Accurate selection of patients with ischemic heart disease and idiopathic dilated cardiomyopathy, who are at risk of sudden cardiac death (SCD), remains a challenge. In these cases, current indications for implantable cardioverter-defibrillators (ICD) rely almost entirely on left ventricular ejection fraction. However, this parameter is insufficient. Recently, noninvasive imaging has provided insight into the mechanism underlying SCD using myocardial deformation on echocardiography and magnetic resonance imaging. The aim of this review article was to underline the emerging role of these novel parameters in identifying high-risk patients.

Methods

A literature search was carried out for reports published with the following terms: “sudden cardiac death,” “heart failure,” “noninvasive imaging,” “echocardiography,” “deformation,” “magnetic resonance imaging,” and “ventricular arrhythmia.” The search was restricted to reports published in English.

Results

The findings of this analysis suggest that cardiac magnetic resonance imaging and strain assessment by echocardiography, particularly longitudinal strain, can be promising techniques for cardiovascular risk stratification in patients with heart failure.

Conclusion

In future, risk stratification of arrhythmia and patient selection for ICD placement may rely on a multiparametric approach using combinations of imaging modalities in addition to left ventricular ejection fraction.

Zusammenfassung

Hintergrund

Die Herzinsuffizienz mit reduzierter Ejektionsfraktion ist eine häufige Erkrankung mit schlechter Prognose. Die genaue Auswahl von Patienten mit koronarer Herzkrankheit und idiopathischer dilatativer Kardiomyopathie, bei denen das Risiko des plötzlichen Herztods besteht, bleibt eine Herausforderung. In diesen Fällen basieren die aktuellen Indikationen für implantierbare kardiale Defibrillatoren (ICD) fast vollständig auf der linksventrikulären Ejektionsfraktion. Allerdings ist dieser Parameter unzureichend. In letzter Zeit hat die nichtinvasive Bildgebung anhand der myokardialen Deformation in der Echokardiographie und in der Magnetresonanztomographie (MRT) Einblicke in den Mechanismus eröffnet, der dem plötzlichen Herztod zugrunde liegt. Ziel der vorliegenden Übersichtsarbeit war es, die aufkommende Bedeutung dieser neuen Parameter für die Erkennung von Hochrisikopatienten hervorzuheben.

Methoden

Dazu wurde eine Literatursuche in Bezug auf Publikationen mit den folgenden Begriffen durchgeführt: „sudden cardiac death“, „heart failure“, „noninvasive imaging“, „echocardiography“, „deformation“, „magnetic resonance imaging“ und „ventricular arrhythmia“. Die Suche war begrenzt auf englischsprachig veröffentlichte Arbeiten.

Ergebnisse

Die Ergebnisse dieser Auswertung weisen darauf hin, dass die kardiale MRT und die Beurteilung des Strains mittels Echokardiographie, insbesondere des longitudinalen Strains, vielversprechende Ansätze für die kardiovaskuläre Risikostratifizierung bei Patienten mit Herzinsuffizienz sein können.

Schlussfolgerung

In Zukunft könnten die Risikostratifizierung für Arrhythmien und die Patientenauswahl für eine ICD-Implantation auf einem multiparametrischen Ansatz basieren, bei dem Kombinationen von Bildgebungsmodalitäten zusätzlich zur linksventrikulären Ejektionsfraktion verwendet werden.

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References

  1. Zipes DP, Wellens HJ (1998) Sudden cardiac death. Circulation 98(21):2334–2351

    Article  PubMed  CAS  Google Scholar 

  2. Tamburro P, Wilber D (1992) Sudden death in idiopathic dilated cardiomyopathy. Am Heart J 124(4):1035–1045

    Article  PubMed  CAS  Google Scholar 

  3. Ezekowitz JA, Armstrong PW, McAlister FA (2003) Implantable cardioverter defibrillators in primary and secondary prevention: a systematic review of randomized, controlled trials. Ann Intern Med 138(6):445–452

    Article  PubMed  Google Scholar 

  4. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R et al (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352(3):225–237

    Article  PubMed  CAS  Google Scholar 

  5. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS et al (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346(12):877–883

    Article  PubMed  Google Scholar 

  6. Bauer A, Barthel P, Schneider R, Ulm K, Müller A, Joeinig A et al (2009) Improved Stratification of Autonomic Regulation for risk prediction in post-infarction patients with preserved left ventricular function (ISAR-Risk). Eur Heart J 30(5):576–583

    Article  PubMed  Google Scholar 

  7. Exner DV, Kavanagh KM, Slawnych MP, Mitchell LB, Ramadan D, Aggarwal SG et al (2007) Noninvasive risk assessment early after a myocardial infarction the REFINE study. J Am Coll Cardiol 50(24):2275–2284

    Article  PubMed  Google Scholar 

  8. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M et al (2015) 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 17(11):1601–1687

    PubMed  Google Scholar 

  9. Moss AJ, Greenberg H, Case RB, Zareba W, Hall WJ, Brown MW et al (2004) Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation 110(25):3760–3765

    Article  PubMed  Google Scholar 

  10. Pennell DJ (2010) Cardiovascular magnetic resonance. Circulation 121(5):692–705

    Article  PubMed  Google Scholar 

  11. Iacoviello M, Monitillo F (2014) Non-invasive evaluation of arrhythmic risk in dilated cardiomyopathy: from imaging to electrocardiographic measures. World J Cardiol 6(7):562–576

    Article  PubMed  PubMed Central  Google Scholar 

  12. Russo AM, Stainback RF, Bailey SR, Epstein AE, Heidenreich PA, Jessup M et al (2013) ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. Heart Rhythm 10(4):e11–e58

    Article  PubMed  Google Scholar 

  13. Gorgels APM, Gijsbers C, de Vreede-Swagemakers J, Lousberg A, Wellens HJJ (2003) Out-of-hospital cardiac arrest--the relevance of heart failure. The Maastricht Circulatory Arrest Registry. Eur Heart J 24(13):1204–1209

    Article  PubMed  Google Scholar 

  14. Kadish A, Dyer A, Daubert JP, Quigg R, Estes NAM, Anderson KP et al (2004) Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 350(21):2151–2158

    Article  PubMed  CAS  Google Scholar 

  15. Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E, Jensen G, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Gustafsson F, Egstrup K, Videbæk R, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pehrson S, DANISH Investigators (2016) Defibrillator Implantation in patients with nonischemic systolic heart failure. N Engl J Med 375:1221–1230

    Article  PubMed  Google Scholar 

  16. Halliday BP, Cleland JGF, Goldberger JJ, Prasad SK (2017) Personalizing risk stratification for sudden death in dilated cardiac the past, present, and future. Circulation 136:215–231

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gonzalez JA, Kramer CM (2015) Role of imaging techniques for diagnosis, prognosis and management of heart failure patients: cardiac magnetic resonance. Curr Heart Fail Rep 12(4):276–283

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Cheong BYC, Muthupillai R, Wilson JM, Sung A, Huber S, Amin S et al (2009) Prognostic significance of delayed-enhancement magnetic resonance imaging: survival of 857 patients with and without left ventricular dysfunction. Circulation 120(21):2069–2076

    Article  PubMed  Google Scholar 

  19. Roes SD, Borleffs CJW, van der Geest RJ, Westenberg JJM, Marsan NA, Kaandorp TAM et al (2009) Infarct tissue heterogeneity assessed with contrast-enhanced MRI predicts spontaneous ventricular arrhythmia in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillator. Circ Cardiovasc Imaging 2(3):183–190

    Article  PubMed  Google Scholar 

  20. Bello D, Fieno DS, Kim RJ, Pereles FS, Passman R, Song G et al (2005) Infarct morphology identifies patients with substrate for sustained ventricular tachycardia. J Am Coll Cardiol 45(7):1104–1108

    Article  PubMed  Google Scholar 

  21. Klem I, Weinsaft JW, Bahnson TD, Hegland D, Kim HW, Hayes B et al (2012) Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation. J Am Coll Cardiol 60(5):408–420

    Article  PubMed  PubMed Central  Google Scholar 

  22. Yan AT, Shayne AJ, Brown KA, Gupta SN, Chan CW, Luu TM et al (2006) Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation 114(1):32–39

    Article  PubMed  Google Scholar 

  23. Flett AS, Hasleton J, Cook C, Hausenloy D, Quarta G, Ariti C et al (2011) Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance. JACC Cardiovasc Imaging 4(2):150–156

    Article  PubMed  Google Scholar 

  24. Gao P, Yee R, Gula L, Krahn AD, Skanes A, Leong-Sit P et al (2012) Prediction of arrhythmic events in ischemic and dilated cardiomyopathy patients referred for implantable cardiac defibrillator: evaluation of multiple scar quantification measures for late gadolinium enhancement magnetic resonance imaging. Circ Cardiovasc Imaging 5(4):448–456

    Article  PubMed  Google Scholar 

  25. Scott PA, Rosengarten JA, Curzen NP, Morgan JM (2013) Late gadolinium enhancement cardiac magnetic resonance imaging for the prediction of ventricular tachyarrhythmic events: a meta-analysis. Eur J Heart Fail 15(9):1019–1027

    Article  PubMed  CAS  Google Scholar 

  26. Assomull RG, Prasad SK, Lyne J, Smith G, Burman ED, Khan M et al (2006) Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol 48(10):1977–1985

    Article  PubMed  Google Scholar 

  27. Bogun FM, Desjardins B, Good E, Gupta S, Crawford T, Oral H et al (2009) Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy: utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol 53(13):1138–1145

    Article  PubMed  PubMed Central  Google Scholar 

  28. Pimentel M, Zimerman LI, Rohde LE (2014) Stratification of the risk of sudden death in nonischemic heart failure. Arq Bras Cardiol 103(4):348–357

    PubMed  PubMed Central  Google Scholar 

  29. Nazarian S, Bluemke DA, Lardo AC, Zviman MM, Watkins SP, Dickfeld TL et al (2005) Magnetic resonance assessment of the substrate for inducible ventricular tachycardia in nonischemic cardiomyopathy. Circulation 112(18):2821–2825

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wu KC, Weiss RG, Thiemann DR, Kitagawa K, Schmidt A, Dalal D et al (2008) Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. J Am Coll Cardiol 51(25):2414–2421

    Article  PubMed  PubMed Central  Google Scholar 

  31. Suzuki T, Nazarian S, Jerosch-Herold M, Chugh SS (2016) Imaging for assessment of sudden death risk: current role and future prospects. Europace 18:1491–1500

    Article  PubMed  PubMed Central  Google Scholar 

  32. Neilan TG, Coelho-Filho OR, Danik SB, Shah RV, Dodson JA, Verdini DJ et al (2013) CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy. JACC Cardiovasc Imaging 6(9):944–954

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kuruvilla S, Adenaw N, Katwal AB, Lipinski MJ, Kramer CM, Salerno M (2014) Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis. Circ Cardiovasc Imaging 7(2):250–258

    Article  PubMed  Google Scholar 

  34. Gulati A, Jabbour A, Ismail TF, Guha K, Khwaja J, Raza S et al (2013) Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. JAMA 309(9):896–908

    Article  PubMed  CAS  Google Scholar 

  35. Disertori M, Rigoni M, Pace N, Casolo G, Masè M, Gonzini L, Lucci D (2016) Myocardial fibrosis assessment by LGE is a powerful predictorOf ventricular tachyarrhythmias in ischemic and nonischemic LV dysfunction: a meta-analysis. JACC Cardiovasc Imaging 9:1046–1055

    Article  PubMed  Google Scholar 

  36. Di Marco A, Anguera I, Schmitt M, Klem I, Neilan T, White JA (2017) Sramko Late gadolinium enhancement and the risk for ventricular arrhythmias or sudden death in dilated cardiomyopathy: systematic review and meta-analysis. JACC Heart Fail 5:28–38

    Article  PubMed  Google Scholar 

  37. Halliday BP (2017) Association Between Midwall Late Gadolinium Enhancement and Sudden Cardiac Death in Patients With Dilated Cardiomyopathy and Mild and Moderate Left Ventricular Systolic Dysfunction. Circulation 135:2106–2115

    Article  PubMed  PubMed Central  Google Scholar 

  38. Iles L, Pfluger H, Lefkovits L, Butler MJ, Kistler PM, Kaye DM et al (2011) Myocardial fibrosis predicts appropriate device therapy in patients with implantable cardioverter-defibrillators for primary prevention of sudden cardiac death. J Am Coll Cardiol 57(7):821–828

    Article  PubMed  Google Scholar 

  39. Lehrke S, Lossnitzer D, Schöb M, Steen H, Merten C, Kemmling H et al (2011) Use of cardiovascular magnetic resonance for risk stratification in chronic heart failure: prognostic value of late gadolinium enhancement in patients with non-ischaemic dilated cardiomyopathy. Heart Br Card Soc 97(9):727–732

    Article  Google Scholar 

  40. Li X, Chan C‑P, Hua W, Ding L, Wang J, Zhang S et al (2013) Prognostic impact of late gadolinium enhancement by cardiac magnetic resonance imaging in patients with non-ischaemic dilated cardiomyopathy. Int J Cardiol 168(5):4979–4980

    Article  PubMed  Google Scholar 

  41. Müller KAL, Müller I, Kramer U, Kandolf R, Gawaz M, Bauer A et al (2013) Prognostic value of contrast-enhanced cardiac magnetic resonance imaging in patients with newly diagnosed non-ischemic cardiomyopathy: cohort study. Plos One 8(2):e57077

    Article  PubMed  PubMed Central  Google Scholar 

  42. Nahum J, Bensaid A, Dussault C, Macron L, Clémence D, Bouhemad B et al (2010) Impact of longitudinal myocardial deformation on the prognosis of chronic heart failure patients. Circ Cardiovasc Imaging 3(3):249–256

    Article  PubMed  Google Scholar 

  43. Jablonowski R (2017) Cardiovascular magnetic resonance to predict appropriate implantable cardioverter defibrillator therapy in Ischemicand nonischemic cardiomyopathy patients using late gadolinium enhancement border zone comparison of four analysis method. Circ Cardiovasc Imaging 10:e6105

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kalam K, Otahal P, Marwick TH (2014) Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart Br Card Soc 100(21):1673–1680

    Google Scholar 

  45. Antoni ML, Mollema SA, Delgado V, Atary JZ, Borleffs CJW, Boersma E et al (2010) Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J 31(13):1640–1647

    Article  PubMed  Google Scholar 

  46. Bertini M, Ng ACT, Antoni ML, Nucifora G, Ewe SH, Auger D et al (2012) Global longitudinal strain predicts long-term survival in patients with chronic ischemic cardiomyopathy. Circ Cardiovasc Imaging 5(3):383–391

    Article  PubMed  Google Scholar 

  47. Iacoviello M, Puzzovivo A, Guida P, Forleo C, Monitillo F, Catanzaro R et al (2013) Independent role of left ventricular global longitudinal strain in predicting prognosis of chronic heart failure patients. Echocardiography 30(7):803–811

    Article  PubMed  Google Scholar 

  48. Zhang KW, French B, Khan MA, Plappert T, Fang JC, Sweitzer NK et al (2014) Strain improves risk prediction beyond ejection fraction in chronic systolic heart failure. J Am Heart Assoc 3(1):e550

    Article  PubMed  PubMed Central  Google Scholar 

  49. Mignot A, Donal E, Zaroui A, Reant P, Salem A, Hamon C et al (2010) Global longitudinal strain as a major predictor of cardiac events in patients with depressed left ventricular function: a multicenter study. J Am Soc Echocardiogr 23(10):1019–1024

    Article  PubMed  Google Scholar 

  50. Motoki H, Borowski AG, Shrestha K, Troughton RW, Tang WHW, Thomas JD et al (2012) Incremental prognostic value of assessing left ventricular myocardial mechanics in patients with chronic systolic heart failure. J Am Coll Cardiol 60(20):2074–2081

    Article  PubMed  Google Scholar 

  51. Ng ACT, Bertini M, Borleffs CJW, Delgado V, Boersma E, Piers SRD et al (2010) Predictors of death and occurrence of appropriate implantable defibrillator therapies in patients with ischemic cardiomyopathy. Am J Cardiol 106(11):1566–1573

    Article  PubMed  Google Scholar 

  52. Bertini M, Ng ACT, Borleffs CJW, Delgado V, Wijnmaalen AP, Nucifora G et al (2010) Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy. Am Heart J 160(4):729–736

    Article  PubMed  Google Scholar 

  53. Haugaa KH, Grenne BL, Eek CH, Ersbøll M, Valeur N, Svendsen JH et al (2013) Strain echocardiography improves risk prediction of ventricular arrhythmias after myocardial infarction. JACC Cardiovasc Imaging 6(8):841–850

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Ariana Hospital, 2080, Ariana, Tunisia

    Ikram Kammoun, Emna Bennour, Lobna Laroussi, Manel Miled, Ahmed Sghaier, Karmous Rahma, Boussema Amine, Sonia Marrakchi & Salem Kachboura

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  1. Ikram Kammoun
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Correspondence to Ikram Kammoun.

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I. Kammoun, E. Bennour, L. Laroussi, M. Miled, A. Sghaier, K. Rahma, B. Amine, S. Marrakchi and S. Kachboura declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Kammoun, I., Bennour, E., Laroussi, L. et al. Risk stratification for sudden cardiac death in patients with heart failure. Herz 46, 550–557 (2021). https://doi.org/10.1007/s00059-021-05032-3

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