Sudden Cardiac Death Prevention in Patients with Ischemic Heart Disease—Beyond the Ejection Fraction

Hillel Steiner, Itzhak Sharabi, Ilan Goldenberg*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Sudden cardiac death (SCD) in patients with ischemic heart disease remains a leading cause of death. Prediction of who is at risk is based on the left ventricular ejection fraction (EF). However, the majority of victims of SCD have a normal EF, and the majority of patients implanted with an implantable cardioverter- defibrillator based on their EF are never treated by their device. Several parameters could allow better prediction of SCD. Several signs on the ECG and Periodic Repolarization Dynamics have been associated with increased risk. Elevated serum biomarkers such as pro-B type natriuretic peptides and serum soluble suppression of tumorigenicity 2 protein (sST2) are predictive of SCD. On the echocardiogram, global longitudinal strain, speckle tracking and relative wall thickness have been implicated. Programmed ventricular stimulation studies and cardiac magnetic resonance are promising modalities that could be further investigated. In conclusion, the EF is an imperfect tool for predicting SCD. Using the modalities reviewed, a model could be created for better prediction of patients at risk.

Original languageEnglish
Article number409
JournalReviews in Cardiovascular Medicine
Issue number12
StatePublished - Dec 2022


  • biomarkers
  • cardiac magnetic resonance imaging
  • echocardiography
  • electrocardiography
  • ischemic heart disease
  • programmed ventricular stimulation
  • risk stratification
  • sudden cardiac death


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