Author + information
- Received July 11, 2014
- Revision received November 14, 2014
- Accepted November 20, 2014
- Published online April 1, 2015.
- Tomas G. Neilan, MD∗,†,
- Hoshang Farhad, MD‡,
- Thomas Mayrhofer, PhD†,
- Ravi V. Shah, MD‡,
- John A. Dodson, MD‡,
- Siddique A. Abbasi, MD‡,
- Stephan B. Danik, MD§,
- Daniel J. Verdini, MD†,
- Michifumi Tokuda, MD‡,
- Usha B. Tedrow, MD‡,
- Michael Jerosch-Herold, PhD‖,
- Udo Hoffmann, MD, MPH†,
- Brian B. Ghoshhajra, MD†,
- William G. Stevenson, MD‡ and
- Raymond Y. Kwong, MD, MPH‡∗ ()
- ∗Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- †Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
- ‡Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- §Division of Cardiology, Department of Medicine, Mount Sinai St. Luke’s Roosevelt Hospital, New York, New York
- ‖Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Raymond Y. Kwong, Cardiac Magnetic Resonance Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115.
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.
This work was supported by an American Heart Association Fellow to Faculty grant to Dr. Neilan (12FTF12060588) and National Institutes of Health research grants to Dr. Jerosch-Herold (R01HL090634-01A1) and Dr. Kwong (R01HL091157). Dr. Farhad is supported in part by the AstraZeneca Scholarship of the Swiss Society of Hypertension. Dr. Tedrow has received honorarium from Medtronic and St. Jude Medical; and research funding from St. Jude Medical and Biosense Webster. Dr. Ghoshhajra has received honoraria from Siemens Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 11, 2014.
- Revision received November 14, 2014.
- Accepted November 20, 2014.
- 2015 American College of Cardiology Foundation