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G Ital Cardiol (Rome). 2015 Nov;16(11):651-66. doi: 10.1714/2066.22442.

[Remarks on polyparametric assessment of sudden death risk for primary prevention ICD implantation in patients with left ventricular dysfunction of ischemic and non ischemic etiology. Italian Association of Hospital Cardiologists (ANMCO) Experts Position Paper].

[Article in Italian]

Author information

1
Dipartimento di Cardiologia, APSS - Progetto Innovazione e Ricerca Clinica in Sanità, PAT-FBK, Trento.
2
U.O. Cardiologia, Ospedale Garibaldi-Nesima, Catania.
3
U.O. Cardiologia, Ospedale Versilia, Lido di Camaiore (LU).
4
Cardiologia, Casa di Cura Polispecialistica Pederzoli, Peschiera del Garda (VR).
5
Centro Cardiovascolare, Azienda per l'Assistenza Sanitaria n. 1, Università degli Studi, Trieste.
6
U.O. Cardiologia, A.O. Istituti Ospitalieri, Cremona.
7
Dipartimento Cardiotoracovascolare "A. De Gasperis", A.O. Ospedale Niguarda Ca' Granda, Milano.
8
Cardiovascular Institute, University of Colorado Denver AMC, Aurora, Colorado, USA.
9
Clinica Cardiologica, Ospedale di Circolo e Fondazione Macchi, Università degli Studi dell'Insubria, Varese.
10
GVM Care & Research, Ospedale Maria Cecilia, Cotignola (RA), ES Health Science Foundation.

Abstract

It is generally recognized that current guidelines, based on ejection fraction criteria, do not allow appropriate selection of patients for implantable cardioverter-defibrillator (ICD) therapy in the primary prevention of sudden death, thus hindering the optimal use of ICD in patients with left ventricular dysfunction of ischemic and nonischemic etiology. Ejection fraction alone has limitations in both sensitivity and specificity. Assessment of the risk for sudden death using a combination of multiple tests (ejection fraction associated with one or more different arrhythmic risk markers) could partially compensate for these limitations. In this position paper, the potential usefulness of a polyparametric assessment using some of the most investigated risk markers of sudden death is discussed, including late gadolinium enhancement cardiac magnetic resonance, programmed ventricular stimulation, T-wave alternans, autonomic tone, biomarkers, and genetic testing.

PMID:
26571481
DOI:
10.1714/2066.22442
[Indexed for MEDLINE]

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