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Life-Threatening Ventricular Arrhythmias: Current Role of Imaging in Diagnosis and Risk Assessment

  • Review Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Sudden cardiac arrest continues to be a major cause of death from cardiovascular disease but our ability to predict patients at the highest risk of developing lethal ventricular arrhythmias remains limited. Left ventricular ejection fraction is inversely related to the risk of sudden death but has a low sensitivity and specificity for the population at risk. Nevertheless, it continues to be the main variable considered in identifying patients most likely to benefit from implantable defibrillators to prevent sudden death. Imaging myocardial sympathetic innervation with PET and SPECT as well as imaging characteristics of myocardial infarcts using gadolinium-enhanced cardiac magnetic resonance are emerging as imaging modalities that may further refine patient selection beyond ejection fraction. This review will primarily focus on employing advanced imaging approaches to identify patients with left ventricular dysfunction that are most likely to develop lethal arrhythmias and benefit from inserting a primary prevention implantable cardiac defibrillator. While not yet tested in prospective studies, we will review risk prediction models incorporating quantitative imaging and biomarkers that have been developed that appear promising to identify those at highest risk of sudden death.

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Abbreviations

SCA:

Sudden cardiac arrest

ICD:

Implantable cardioverter defibrillator

LVEF:

Left ventricular ejection fraction

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

123I-mIBG:

123I-meta-iodobenzylguanidine

11C-HED:

11C-meta-hydroxyephedrine

HMR:

Heart-to-mediastinum ratio

ADMIRE-HF:

AdreView Myocardial Imaging for Risk Evaluation in Heart Failure

PAREPET:

Prediction of Arrhythmic Events with Positron Emission Tomography

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Authors and Affiliations

  1. Department of Medicine, University at Buffalo, Buffalo, NY, USA

    Saurabh Malhotra MD, MPH, FASNC & John M. Canty Jr. MD

  2. Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA

    John M. Canty Jr. MD

  3. Department of Physiology and Biophysics, University at Buffalo, Buffalo, NY, USA

    John M. Canty Jr. MD

  4. The VA WNY Health Care System, University at Buffalo, Buffalo, NY, USA

    John M. Canty Jr. MD

  5. Division of Cardiovascular Medicine, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott St., Suite 7030, Buffalo, NY, 14203, USA

    Saurabh Malhotra MD, MPH, FASNC & John M. Canty Jr. MD

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  1. Saurabh Malhotra MD, MPH, FASNC
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  2. John M. Canty Jr. MD
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Correspondence to John M. Canty Jr. MD.

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Supported by the National Heart Lung and Blood Institute (HL-055324, HL-061610), the Department of Veterans Affairs, the Albert and Elizabeth Rekate Fund in Cardiovascular Medicine and the National Center for Advancing Translational Sciences (UL1TR001412)

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Malhotra, S., Canty, J.M. Life-Threatening Ventricular Arrhythmias: Current Role of Imaging in Diagnosis and Risk Assessment. J. Nucl. Cardiol. 23, 1322–1334 (2016). https://doi.org/10.1007/s12350-015-0392-0

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