title: Life-Threatening Ventricular Arrhythmias: Current Role of Imaging in Diagnosis and Risk Assessment.
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.
authors.affiliation: Department of Medicine, University at Buffalo, Buffalo, NY, USA.|Division of Cardiovascular Medicine, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott St., Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Malhotra
authors.affiliation: Department of Medicine, University at Buffalo, Buffalo, NY, USA. canty@buffalo.edu.|Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA. canty@buffalo.edu.|Department of Physiology and Biophysics, University at Buffalo, Buffalo, NY, USA. canty@buffalo.edu.|The VA WNY Health Care System, University at Buffalo, Buffalo, NY, USA. canty@buffalo.edu.|Division of Cardiovascular Medicine, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott St., Suite 7030, Buffalo, NY, 14203, USA. canty@buffalo.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Canty
keywords: 11C-hydroxyephedrine; 123I-metaiodobenzylguanidine; Sudden cardiac arrest; gadolinium MRI; risk stratification