[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]

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


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.

Publication types

  • English Abstract

MeSH terms

  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable*
  • Humans
  • Italy
  • Patient Selection
  • Practice Guidelines as Topic
  • Primary Prevention / methods
  • Risk Assessment / methods
  • Sensitivity and Specificity
  • Ventricular Dysfunction, Left / complications
  • Ventricular Dysfunction, Left / therapy*