This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gerson, M. C. Articles by Costea, A. I. Search for Related Content PubMed Articles by Gerson, M. C. Articles by Costea, A. I.

Will Imaging Assist in the Selection of Patients With Heart Failure for an ICD?

Myron C. Gerson, MD^_*,,_*, Mouhamad Abdallah, MD^_*, James N. Muth, MD, PhD^_*, Alexandru I. Costea, MD^_*

^_* Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio
E. L. Saenger Radioisotope Laboratory, University Hospital of Cincinnati, Cincinnati, Ohio

^_* Reprint requests and correspondence: Dr. Myron C. Gerson, University of Cincinnati College of Medicine, Division of Cardiovascular Diseases, P.O. Box 670542, Cincinnati, Ohio 45267-0542 (Email: myron.gerson{at}uc.edu).

Sudden cardiac death remains the leading cause of death in the U.S. A left ventricular ejection fraction (LVEF) <30% to 35% identifies a population of patients at increased risk for sudden cardiac death. Once identified, an implantable cardioverter-defibrillator (ICD) is effective in reducing the occurrence of sudden cardiac death. Yet in a substantial proportion of patients who receive an ICD based on reduced LVEF, the device never delivers therapy. Furthermore, the majority of patients who die suddenly do not qualify for ICD placement under current LVEF-based criteria in the guidelines. This review considers the potential role of cardiac imaging in improving the selection of patients most likely to benefit from an ICD. The presence of myocardial scar and/or unrevascularized myocardial ischemia provides an important substrate for the occurrence of potentially fatal ventricular arrhythmias. The presence of clinical heart failure further increases the risk of ventricular arrhythmia. The sympathetic nervous system provides an important trigger for major arrhythmic events, both through global overactivity and through regional heterogeneity of sympathetic activity. A mismatch of myocardial perfusion and innervation may pose a particularly great risk. Imaging modalities provide unique opportunities to investigate the anatomic and pathophysiologic substrates, as well as the triggering effects of cardiac sympathetic innervation. Combining imaging and electrophysiologic modalities offers promise for improved accuracy in future selection of patients with heart failure for ICD placement.

Key Words: implanted cardioverter defibrillator • sympathetic nervous system • [¹²³I]meta-iodobenzylguanidine • [¹¹C]hydroxyephedrine • cardiac magnetic resonance • heart failure

Abbreviations and Acronyms   BNP = B-type natriuretic peptide   CMR = cardiac magnetic resonance   H/M = heart to mediastinum   ICD = implantable cardioverter-defibrillator   LVEF = left ventricular ejection fraction   mIBG = meta-iodobenzylguanidine   NYHA = New York Heart Association   PET = positron emission tomography   SCD = sudden cardiac death   SPECT = single-photon emission computed tomography

This article has been cited by other articles:

				W. A. Zoghbi and J. Narula Is Mechanical Dispersion a Raven of Ventricular Arrhythmias? J. Am. Coll. Cardiol. Img., March 1, 2010; 3(3): 330 - 331. [Full Text] [PDF]

				V. Dilsizian, Y. Chandrashekhar, and J. Narula Introduction of New Tests: Low Are the Mountains, High the Expectations J. Am. Coll. Cardiol. Img., January 1, 2010; 3(1): 117 - 119. [Full Text] [PDF]