Improved Prediction of Sudden Cardiac Death Risk

Risk stratification of patients to identify those who will benefit most from the primary prevention implantable cardioverter-defibrillator (ICD) remains a challenge. For the last decade, measurement of the left ventricular ejection fraction (LVEF) as a clinical risk predictor is recognized to be inadequate. In fact, contemporary real world data indicate that of the patients identified using this methodology, the proportion of patients who benefit from the ICD at the end of a year may be as low as 1.1%. It is also accepted, however, that novel noninvasive imaging techniques will make major strides toward this goal in the near future. In this context, the low-hanging fruit is the potential role of risk markers measured from the same echocardiogram that would provide the LVEF. In this issue of Circulation: Cardiovascular Imaging, Konety et al report their results regarding the association between multiple echocardiographic predictors and risk of sudden cardiac death (SCD) in a meta-analysis performed from the ARIC (Atherosclerosis Risk in Communities) and CHS (Cardiovascular Health Study) cohorts. It is worth deliberating on their findings in the setting of existing knowledge, as well as the specific methodology used in their analysis.