Considerazioni su una valutazione poliparametrica nella stratificazione del rischio di morte improvvisa per l'indicazione all'impianto di cardioverter-defibrillatore in prevenzione primaria, nella disfunzione ventricolare sinistra di origine ischemica e non ischemica. Position paper dell'Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)

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.