Clinical Scorecard: Differentiating Sustained Ventricular Tachycardia in Structural Heart Disease Through LGE-CMR and Computational Modeling: Advancing Beyond Left Ventricular Ejection Fraction

At a Glance

Key Highlights

• Lower LVEF and visual LGE positivity are associated with sustained VT.
• LGE-positive patients with sustained VT have larger core scars and grey zones.
• The LGE-VTsim index effectively discriminates sustained VT beyond LVEF.
• Sustained VT is a major cause of sudden cardiac death in SHD.
• Current guidelines primarily rely on LVEF ≤ 35% for ICD therapy.

Guideline-Based Recommendations

Diagnosis

• Use LVEF and visual LGE assessment for risk stratification.
• Consider LGE-CMR for detailed characterization of arrhythmogenic substrate.

Management

• ICD implantation is recommended for patients at high risk of sudden cardiac death.

Monitoring & Follow-up

• Conduct clinical and arrhythmia assessments within 6 months post-CMR.

Risks

• A significant proportion of sudden cardiac death occurs in patients with LVEF >35%.

Patient & Prescribing Data

Patients with structural heart disease (SHD) undergoing LGE-CMR.

Guideline-directed medical therapy has reduced SCD incidence, but residual risk remains.

Clinical Best Practices

• Utilize LGE-CMR for comprehensive scar assessment.
• Incorporate computational modeling for personalized risk stratification.

Related Resources & Content

• Study Protocol Approval