Recent Non-Invasive Parameters to Identify Subjects at High Risk of Sudden Cardiac Death

Abstract

Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. This review aims to provide an update on the most relevant non-invasive diagnostic features to identify patients at higher risk of developing malignant ventricular arrhythmias and SCD.

Keywords: ECG; cardiac magnetic resonance; genetic testing; prognosis; sudden cardiac death.

Figure 1

Figure summarizes the features related to increased risk of ventricular arrhythmias obtained by ECG, imaging (echocardiography and cardiac magnetic resonance) and genetic techniques. BrS: Brugada Syndrome; ER: early repolarization; LV: left ventricular; QRSf: fragmented QRS.

Figure 2

In the left panel T2-STIR (a) and PSIR-TFE (b) sequences showing increased signal predominantly subepicardial patchy of the left ventricular wall due to necrosis of acute myocarditis. In the right panel sequence T1-TSE and T1-Fat Sat (c) showing multiple areas of adipose infiltration with mesocardial and subepicardial distribution of the left ventricle walls, (d) extended subepicardial signal hyperintensity in PSIR sequences for the study of “Late Gadolinium Enhancement” indicative of fibrosis for Left Dominant Arrhythmogenic Dysplasia.