Late gadolinium enhancement among survivors of sudden cardiac arrest.

Abstract

OBJECTIVES:

The aim of this study was to describe the role of contrast-enhanced cardiac magnetic resonance (CMR) in the workup of patients with aborted sudden cardiac arrest (SCA) and in the prediction of long-term outcomes.

BACKGROUND:

Myocardial fibrosis is a key substrate for SCA, and late gadolinium enhancement (LGE) on a CMR study is a robust technique for imaging of myocardial fibrosis.

METHODS:

We performed a retrospective review of all survivors of SCA who were referred for CMR studies and performed follow-up for the subsequent occurrence of an adverse event (death and appropriate defibrillator therapy).

RESULTS:

After a workup that included a clinical history, electrocardiogram, echocardiography, and coronary angiogram, 137 patients underwent CMR for workup of aborted SCA (66% male; mean age 56 ± 11 years; left ventricular ejection fraction 43 ± 12%). The presenting arrhythmias were ventricular fibrillation (n = 105 [77%]) and ventricular tachycardia (n = 32 [23%]). Overall, LGE was found in 98 patients (71%), with an average extent of 9.9 ± 5% of the left ventricular myocardium. CMR imaging provided a diagnosis or an arrhythmic substrate in 104 patients (76%), including the presence of an infarct-pattern LGE in 60 patients (44%), noninfarct LGE in 21 (15%), active myocarditis in 14 (10%), hypertrophic cardiomyopathy in 3 (2%), sarcoidosis in 3, and arrhythmogenic cardiomyopathy in 3. In a median follow-up of 29 months (range 18 to 43 months), there were 63 events. In a multivariable analysis, the strongest predictors of recurrent events were the presence of LGE (adjusted hazard ratio: 6.7; 95% CI: 2.38 to 18.85; p < 0.001) and the extent of LGE (hazard ratio: 1.15; 95% CI: 1.11 to 1.19; p < 0.001).

CONCLUSIONS:

Among patients with SCA, CMR with contrast identified LGE in 71% and provided a potential arrhythmic substrate in 76%. In follow-up, both the presence and extent of LGE identified a group at markedly increased risk of future adverse events.

• Authors: Tomas G Neilan, Hoshang Farhad, Thomas Mayrhofer, Ravi V Shah, John A Dodson, Siddique A Abbasi, Stephan B Danik, Daniel J Verdini, Michifumi Tokuda, Usha B Tedrow, Michael Jerosch-Herold, Udo Hoffmann, Brian B Ghoshhajra, William G Stevenson, Raymond Y Kwong
• Journal: JACC. Cardiovascular imaging (JACC Cardiovasc Imaging) Vol. 8 Issue 4 Pg. 414-423 (Apr 2015) ISSN: 1876-7591 [Electronic] United States
• PMID: 25797123 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Contrast Media
• Gadolinium

Topics

• Contrast Media
• Coronary Angiography
• Death, Sudden, Cardiac (pathology)
• Echocardiography
• Electrocardiography
• Female
• Follow-Up Studies
• Gadolinium
• Humans
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Prospective Studies
• Retrospective Studies
• Survivors