Life-Threatening Ventricular Arrhythmias: Current Role of Imaging in Diagnosis and Risk Assessment
Saurabh Malhotra, John M Canty Jr, Saurabh Malhotra, John M Canty Jr
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.
Keywords: 11C-hydroxyephedrine; 123I-metaiodobenzylguanidine; Sudden cardiac arrest; gadolinium MRI; risk stratification.
Figures
![Figure 1. Schematic of Sympathetic Transmission](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5691607/bin/nihms918342f1.jpg)
![Figure 2. Imaging of Myocardial Flow, Viability,…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5691607/bin/nihms918342f2.jpg)
![Figure 3. Late Gadolinium Enhanced Cardiac Magnetic…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5691607/bin/nihms918342f3.jpg)
![Figure 4. Prediction of Arrhythmic Events by…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5691607/bin/nihms918342f4.jpg)
Figure 5. Sudden Cardiac Arrest Risk Factor…
Figure 5. Sudden Cardiac Arrest Risk Factor Model from PAREPET
PAREPET risk score based on…
- Combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death.Wu KC, Gerstenblith G, Guallar E, Marine JE, Dalal D, Cheng A, Marbán E, Lima JA, Tomaselli GF, Weiss RG. Wu KC, et al. Circ Cardiovasc Imaging. 2012 Mar;5(2):178-86. doi: 10.1161/CIRCIMAGING.111.968024. Epub 2012 Jan 20. Circ Cardiovasc Imaging. 2012. PMID: 22267750 Free PMC article.
- Structural and Physiological Imaging to Predict the Risk of Lethal Ventricular Arrhythmias and Sudden Death.Malhotra S, Canty JM Jr. Malhotra S, et al. JACC Cardiovasc Imaging. 2019 Oct;12(10):2049-2064. doi: 10.1016/j.jcmg.2019.05.034. JACC Cardiovasc Imaging. 2019. PMID: 31601379 Free PMC article. Review.
- Prevalence of myocardial fibrosis patterns in patients with systolic dysfunction: prognostic significance for the prediction of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy.Almehmadi F, Joncas SX, Nevis I, Zahrani M, Bokhari M, Stirrat J, Fine NM, Yee R, White JA. Almehmadi F, et al. Circ Cardiovasc Imaging. 2014 Jul;7(4):593-600. doi: 10.1161/CIRCIMAGING.113.001768. Epub 2014 Jun 5. Circ Cardiovasc Imaging. 2014. PMID: 24902587
- Role of Cardiac Imaging in Evaluating Risk for Sudden Cardiac Death.Macatangay C, Viles-Gonzalez JF, Goldberger JJ. Macatangay C, et al. Card Electrophysiol Clin. 2017 Dec;9(4):639-650. doi: 10.1016/j.ccep.2017.08.001. Card Electrophysiol Clin. 2017. PMID: 29173407 Review.
- Improving the appropriateness of sudden arrhythmic death primary prevention by implantable cardioverter-defibrillator therapy in patients with low left ventricular ejection fraction. Point of view.Disertori M, Gulizia MM, Casolo G, Delise P, Di Lenarda A, Di Tano G, Lunati M, Mestroni L, Salerno-Uriarte J, Tavazzi L. Disertori M, et al. J Cardiovasc Med (Hagerstown). 2016 Apr;17(4):245-55. doi: 10.2459/JCM.0000000000000368. J Cardiovasc Med (Hagerstown). 2016. PMID: 26895401 Free PMC article. Review.
- Myocardial substrate after cardiac resynchronization therapy and the risk of ventricular arrhythmias.Malhotra S. Malhotra S. J Nucl Cardiol. 2017 Aug;24(4):1289-1291. doi: 10.1007/s12350-016-0474-7. Epub 2016 Mar 22. J Nucl Cardiol. 2017. PMID: 27003877 No abstract available.
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![Figure 5. Sudden Cardiac Arrest Risk Factor…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5691607/bin/nihms918342f5.jpg)
Source: PubMed