Author + information
- Received September 16, 2019
- Revision received October 28, 2019
- Accepted October 29, 2019
- Published online December 21, 2019.
- Christoph Gräni, MD, PhDa,b,
- Dominik C. Benz, MDc,
- Sumit Gupta, MDa,
- Stephan Windecker, MDb and
- Raymond Y. Kwong, MD, MPHa,∗ ()
- aNoninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- bDepartment of Cardiology, Swiss Cardiovascular Center, University of Bern, Switzerland
- cCardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Switzerland
- ↵∗Address for correspondence:
Dr. Raymond Y. Kwong, Brigham and Women's Hospital, Cardiovascular Division, Department of Medicine, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115.
• Sudden cardiac death remains a leading cause of cardiovascular deaths in patients with ischemic heart disease, and current risk stratification is limited.
• Further studies are needed for a better risk stratification in these patients.
• Fibrosis is an arrhythmogenic substrate in patients with ischemic heart disease, and cardiac magnetic resonance is the modality of choice to display scar and diffuse fibrosis.
• Cardiac magnetic resonance is a promising tool to improve risk stratification in patients with ischemic heart disease.
Despite substantial medical advances over the past decades, sudden cardiac death (SCD) remains a leading cause of cardiovascular deaths in patients with ischemic heart disease. The presence of structural heart disease with left ventricular ejection fraction <35% is the current criteria for implantable cardioverter-defibrillator therapy as a primary prevention to SCD. However, more than 80% of patients who suffer SCD have a left ventricular ejection fraction >35%, whereas few patients who received an implantable cardioverter-defibrillator required appropriate defibrillation. Cardiac magnetic resonance enables the visualization of the arrhythmogenic myocardial substrate including the presence and pattern of scar and fibrosis. The most promising of these features, besides left ventricular function, strain analysis, and morphology, include tissue characterization using late-gadolinium enhancement, T1 mapping, and extracellular volume fraction calculation. We review the current evidence of SCD relating to ischemic heart disease, provide insights into imaging of the arrhythmogenic substrate that produces lethal ventricular arrhythmia, and discuss how imaging may guide therapies toward SCD prevention.
- cardiac magnetic resonance
- computed tomography
- coronary artery disease
- extracellular volume fraction
- ischemic heart disease
- late gadolinium enhancement
- positron emission tomography
- sudden cardiac death
- ventricular tachycardia
Dr. Gräni has received funding support from the Novartis Foundation for Medical-Biological Research, Bangerter-Rhyner Foundation, Swiss Sports Medicine Society, and Kreislauf Kardiologie Foundation. Dr. Benz has received research grant from Theodor und Ida Herzog-Egli-Foundation. Dr. Windecker has received research grants to the institution from Amgen, Abbott, Bayer, Boston Scientific, Biotronik, Medtronic, Edwards Lifesciences, St Jude, and Terumo. Dr. Kwong has received research funding from the National Institutes of Health, Society for Cardiovascular Magnetic Resonance, and Myokardia Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 16, 2019.
- Revision received October 28, 2019.
- Accepted October 29, 2019.
- 2019 American College of Cardiology Foundation
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