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  • Review Article
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Early identification of risk factors for sudden cardiac death

Nature Reviews Cardiology volume 7, pages 318–326 (2010)Cite this article

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Abstract

Sudden cardiac death (SCD) is a global health issue. The unexpected nature of this devastating condition compounds the urgency of discovering methods for early detection of risk, which will lead to more effective prevention. However, the complex and dynamic nature of SCD continues to present a considerable challenge for the early identification of risk factors. Measurement of the left ventricular ejection fraction (LVEF) is currently the only major risk factor used for stratification in clinical practice. Severely decreased LVEF is likely to manifest late in the natural history of SCD, however, and may only affect a small subgroup of patients who will suffer SCD. A growing body of literature describes novel risk markers and predictors of SCD, such as high-risk phenotypes, genetic variants and biomarkers. This Review will discuss the potential utility of these markers as early identifiers of risk, and suggests a framework for the conduct of future studies for the discovery, validation, and deployment of novel SCD risk factors.

Key Points

  • Sudden cardiac death (SCD) results in 200,000–250,000 deaths in the US every year

  • The left ventricular ejection fraction is currently the only clinical variable used for SCD risk stratification

  • Few risk factors are available owing to the complexity of SCD and its asymptomatic nature; further research is needed to find novel markers that can identify high-risk individuals

  • Phenotypes associated with SCD include left ventricular hypertrophy, prolonged QTc interval, and increased resting heart rate; a genetic susceptibility for SCD also exists

  • Novel risk markers of SCD identified in the blood and from molecular imaging techniques will be used for SCD risk stratification in the future

  • A risk score for early prediction of SCD that consists of a panel of markers will be more effective than any individual marker

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Figure 1: Contribution of severe LV systolic dysfunction to SCD in the general population.
Figure 2: Risk factors associated with SCD in patients with CAD.
Figure 3: Electrocardiographic findings and manifestation of arrhythmia in the Brugada syndrome.
Figure 4: Schematic of genome-wide association study design.
Figure 5: Survival curves (free of SCD) stratified by the protective rs3864180 genotype.
Figure 6: Kaplan–Meier SCD-free curves after cardiac metaiodobenzylguanidine imaging.
Figure 7: Development of an early detection risk score for SCD.

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Acknowledgements

This manuscript was funded, in part, by the National Heart Lung and Blood Institute (R01HL088416). The author is indebted to Drs. Kyndaron Reinier and Eric C. Stecker for their critical review of the manuscript.

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Chugh, S. Early identification of risk factors for sudden cardiac death. Nat Rev Cardiol 7, 318–326 (2010). https://doi.org/10.1038/nrcardio.2010.52

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