Late Gadolinium Enhancement Among Survivors of Sudden Cardiac Arrest

JACC-CARDIOVASCULAR IMAGING

卷:8

Article

Neilan, Tomas G.^1,2  Farhad, Hoshang³  Mayrhofer, Thomas²  Shah, Ravi V.³  Dodson, John A.³  Abbasi, Siddique A.³  Danik, Stephan B.⁴  Verdini, Daniel J.²  Tokuda, Michifumi³  Tedrow, Usha B.³  Jerosch-Herold, Michael⁵  Hoffmann, Udo²  Ghoshhajra, Brian B.²  Stevenson, William G.³  Kwong, Raymond Y.³ 

[1] Massachusetts Gen Hosp, Dept Med, Div Cardiol, Boston, MA 02114 USA

[2] Massachusetts Gen Hosp, Dept Radiol, Cardiac MR PET CT Program, Boston, MA 02114 USA

[3] Brigham & Womens Hosp, Dept Med, Cardiovasc Div, Boston, MA 02115 USA

[4] Mt Sinai St Lukes Roosevelt Hosp, Dept Med, Div Cardiol, New York, NY USA

[5] Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Radiol, Boston, MA 02115 USA

关键词: cardiac magnetic resonance;    implantable cardioverter-defibrillator;    late gadolinium enhancement;   

DOI  :  10.1016/j.jcmg.2014.11.017

来源: Elsevier

【 摘 要 】

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. (C) 2015 by the American College of Cardiology Foundation.

【 授权许可】

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