Bedeutung von kardialer Bildgebung für die Risikostratifikation des plötzlichen Herztods

Zusammenfassung

Der plötzliche Herztod (SCD) bei Kardiomyopathien und entzündlichen Myokarderkrankungen ist mit herkömmlichen Risikomodellen nur eingeschränkt vorherzusagen. Die kardiale Magnetresonanztomografie (CMR) ermöglicht eine nicht invasive Beurteilung arrhythmogener Substrate wie Fibrose, Ödem und Entzündung. Diese Übersichtsarbeit beleuchtet die pathophysiologischen Grundlagen der bildgebungsgestützten SCD-Risikostratifizierung und analysiert die prognostische Relevanz moderner CMR-Techniken wie Late Gadolinium Enhancement (LGE), T1-/T2-Mapping und Strain-Analyse. Ergänzend werden die Rolle weiterer bildgebender Verfahren sowie zukünftige Entwicklungen im Bereich künstlicher Intelligenz und Radiomics dargestellt. Die Integration struktureller, die Gewebecharakterisierung betreffender und funktioneller Bildgebung könnte unter Berücksichtigung von genetischen Befunden und individueller Patientenpräferenz den Übergang von populationsbasierten Schwellenwerten zu einer individualisierten kardiovaskulären Versorgung ermöglichen.

Abstract

Sudden cardiac death (SCD) in cardiomyopathies and inflammatory myocardial diseases remains difficult to predict using conventional risk models. Cardiac magnetic resonance (CMR) imaging provides non-invasive assessment of arrhythmogenic substrates such as fibrosis, edema, and inflammation. This review highlights the pathophysiological basis for imaging-guided SCD risk stratification and examines the prognostic relevance of advanced CMR techniques, including late gadolinium enhancement (LGE), T1/T2 mapping, and strain analysis. We discuss the complementary role of other imaging modalities and outline future directions in risk assessment with artificial intelligence and radiomics. The integration of genetics, in line with structural, tissue-level, and functional imaging into decision-making algorithms may allow a shift from population-based thresholds to personalized cardiovascular care.

Schlüsselwörter

Bildgebung - Risikostratifizierung - plötzlicher Herztod

Keywords

imaging - sudden cardiac death - risk stratification

• Literatur

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