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Scharinger B, Boxhammer E, Rezar R, Hecht S, Wernly S, Widhalm T, Lichtenauer M, Hoppe UC, Hergan K, Wernly B, Strohmer B, Kaufmann R. Cardiac MRI after Sudden Cardiac Arrest: A Systematic Review. Radiol Cardiothorac Imaging 2024; 6:e230216. [PMID: 38634744 PMCID: PMC11056749 DOI: 10.1148/ryct.230216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/08/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
Purpose To perform a systematic review to assess the diagnostic and prognostic value of cardiac MRI after sudden cardiac arrest (SCA). Materials and Methods PubMed and Cochrane Library databases were systematically searched for studies investigating cardiac MRI after SCA in adult patients (≥18 years of age). The time frame of the encompassed studies spans from January 2012 to January 2023. The study protocol was preregistered in OSF Registries (www.osf.io/nxaev), and the systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa quality assessment scale. Results Fourteen studies involving 1367 individuals, 1257 (91.9%) of whom underwent cardiac MRI, were included. Inconsistent findings were reported on the diagnostic value of cardiac MRI-specific findings. The included studies demonstrated the following main findings: (a) cardiac MRI led to a new or alternative diagnosis in patients with SCA; (b) cardiac MRI identified pathologic or arrhythmogenic substrates; (c) cardiac MRI helped detect myocardial edema (potentially reversible); (d) cardiac MRI provided evidence for the occurrence of adverse events; and (e) functional markers or ventricular dimensions were considered prognostically relevant in a few studies. Relevant challenges in this systematic review were the lack of comparators and reference standards relative to cardiac MRI as the index test and patient selection bias. Conclusion Cardiac MRI following SCA can contribute to the diagnostic process and offer supplementary information essential for treatment planning. Limitations of the review include studies with insufficient comparators and potential bias in patient selection. Systematic review registration link: osf.io/nxaev Keywords: Cardiac MRI, Cardiovascular Disease, Cardiomyopathy, Ischemia, Myocardial Edema, Sudden Cardiac Arrest © RSNA, 2024.
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Affiliation(s)
| | | | - Richard Rezar
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Stefan Hecht
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Sarah Wernly
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Tobias Widhalm
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Michael Lichtenauer
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Uta C. Hoppe
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Klaus Hergan
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Bernhard Wernly
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Bernhard Strohmer
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Reinhard Kaufmann
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
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2
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Thomsen AF, Winkel BG, Golvano LCC, Porta-Sánchez A, Jøns C, Ferro E, Bertelsen L, Vazquez S, Bhardwaj P, Stampe NK, Ortiz-Perez JT, Andrea R, Engstrøm T, Køber L, Vejlstrup N, Mont L, Roca-Luque I, Jacobsen PK. Myocardial scarring and recurrence of ventricular arrhythmia in patients surviving an out-of-hospital cardiac arrest. J Cardiovasc Electrophysiol 2023; 34:2286-2295. [PMID: 37681321 DOI: 10.1111/jce.16058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Prediction of recurrent ventricular arrhythmia (VA) in survivors of an out-of-hospital cardiac arrest (OHCA) is important, but currently difficult. Risk of recurrence may be related to presence of myocardial scarring assessed with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Our study aims to characterize myocardial scarring as defined by LGE-CMR in survivors of a VA-OHCA and investigate its potential role in the risk of new VA events. METHODS Between 2015 and 2022, a total of 230 VA-OHCA patients without ST-segment elevation myocardial infarction had CMR before implantable cardioverter-defibrillator implantation for secondary prevention at Copenhagen University Hospital, Rigshospitalet, and Hospital Clínic, University of Barcelona, of which n = 170 patients had a conventional (no LGE protocol) CMR and n = 60 patients had LGE-CMR (including LGE protocol). Scar tissue including core, border zone (BZ) and BZ channels were automatically detected by specialized investigational software in patients with LGE-CMR. The primary endpoint was recurrent VA. RESULTS After exclusion, n = 52 VA-OHCA patients with LGE-CMR and a mean left ventricular ejection fraction of 49 ± 16% were included, of which 18 (32%) patients reached the primary endpoint of VA. Patients with recurrent VA in exhibited greater scar mass, core mass, BZ mass, and presence of BZ channels compared with patients without recurrent VA. The presence of BZ channels identified patients with recurrent VA with 67% sensitivity and 85% specificity (area under the ROC curve (AUC) 0.76; 95% CI: 0.63-0.89; p < .001) and was the strongest predictor of the primary endpoint. CONCLUSIONS The presence of BZ channels was the strongest predictor of recurrent VA in patients with an out of-hospital cardiac arrest and LGE-CMR.
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Affiliation(s)
- Anna F Thomsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Bo G Winkel
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Andreu Porta-Sánchez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Elisenda Ferro
- Arrhythmia Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Litten Bertelsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sara Vazquez
- Arrhythmia Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Priya Bhardwaj
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Kjaer Stampe
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - José T Ortiz-Perez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lluís Mont
- Arrhythmia Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ivo Roca-Luque
- Arrhythmia Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Peter K Jacobsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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3
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Gil KE, Truong VT, Zareba KM, Varghese J, Simonetti OP, Rajpal S. Parametric mapping by cardiovascular magnetic resonance imaging in sudden cardiac arrest survivors. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1547-1555. [PMID: 37147450 DOI: 10.1007/s10554-023-02864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
Etiology of sudden cardiac arrest (SCA) is identified in less than 30% of survivors without coronary artery disease. We sought to assess the diagnostic role of myocardial parametric mapping using cardiovascular magnetic resonance (CMR) in identifying SCA etiology. Consecutive SCA survivors undergoing CMR with myocardial parametric mapping were included in the study. The determination if CMR was decisive or contributory in identifying SCA etiology was made if the diagnosis was unclear prior to CMR, and the discharge diagnosis was consistent with the CMR result. Parametric mapping was considered essential for establishing probable SCA etiology by CMR if the SCA cause could not have been determined without its utilization. If the CMR diagnosis could have been potentially based on the combination of cine and LGE imaging, parametric mapping was considered contributory. Of the 35 patients (mean age 46.9 ± 14.1 years; 57% males) included, SCA diagnosis was based on CMR in 23 (66%) patients. Of those, parametric mapping was essential for the diagnosis of myocarditis and tako-tsubo cardiomyopathy (11/48%) and contributed to the diagnosis in 10 (43%) additional cases. Inclusion of quantitative T1 and T2 parametric mapping in the SCA CMR protocol has the potential to increase diagnostic yield of CMR and further specify SCA etiology, especially myocarditis.
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Affiliation(s)
- Katarzyna E Gil
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 452 W 10th Ave, Columbus, OH, 43210, USA.
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
| | - Vien T Truong
- Department of Internal Medicine, Nazareth Hospital, Pennsylvania, PA, USA
| | - Karolina M Zareba
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 452 W 10th Ave, Columbus, OH, 43210, USA
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Juliet Varghese
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rajpal
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 452 W 10th Ave, Columbus, OH, 43210, USA
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
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4
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Verheul LM, Groeneveld SA, Kirkels FP, Volders PGA, Teske AJ, Cramer MJ, Guglielmo M, Hassink RJ. State-of-the-Art Multimodality Imaging in Sudden Cardiac Arrest with Focus on Idiopathic Ventricular Fibrillation: A Review. J Clin Med 2022; 11:4680. [PMID: 36012918 PMCID: PMC9410297 DOI: 10.3390/jcm11164680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic ventricular fibrillation is a rare cause of sudden cardiac arrest and a diagnosis by exclusion. Unraveling the mechanism of ventricular fibrillation is important for targeted management, and potentially for initiating family screening. Sudden cardiac arrest survivors undergo extensive clinical testing, with a growing role for multimodality imaging, before diagnosing "idiopathic" ventricular fibrillation. Multimodality imaging, considered as using multiple imaging modalities as diagnostics, is important for revealing structural myocardial abnormalities in patients with cardiac arrest. This review focuses on combining imaging modalities (echocardiography, cardiac magnetic resonance and computed tomography) and the electrocardiographic characterization of sudden cardiac arrest survivors and discusses the surplus value of multimodality imaging in the diagnostic routing of these patients. We focus on novel insights obtained through electrostructural and/or electromechanical imaging in apparently idiopathic ventricular fibrillation patients, with special attention to non-invasive electrocardiographic imaging.
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Affiliation(s)
- Lisa M. Verheul
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Sanne A. Groeneveld
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Feddo P. Kirkels
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Paul G. A. Volders
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Arco J. Teske
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Maarten J. Cramer
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marco Guglielmo
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger J. Hassink
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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5
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Zorzi A, Mattesi G, Baldi E, Toniolo M, Guerra F, Cauti FM, Cipriani A, De Lazzari M, Muser D, Stronati G, Marcantoni L, Manfrin M, Calò L, Lanzillo C, Perazzolo Marra M, Savastano S, Corrado D. Prognostic Role of Myocardial Edema as Evidenced by Early Cardiac Magnetic Resonance in Survivors of Out-of-Hospital Cardiac Arrest: A Multicenter Study. J Am Heart Assoc 2021; 10:e021861. [PMID: 34779249 PMCID: PMC8751964 DOI: 10.1161/jaha.121.021861] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
Background Sudden cardiac arrest (SCA) may be caused by an acute and reversible myocardial injury, a chronic and irreversible myocardial damage, or a primary ventricular arrhythmia. Cardiac magnetic resonance imaging may identify myocardial edema (ME), which denotes acute and reversible myocardial damage. We evaluated the arrhythmic outcome of SCA survivors during follow-up and tested the prognostic role of ME. Methods and Results We included a consecutive series of 101 (71% men, median age 47 years) SCA survivors from 9 collaborative centers who underwent early (<1 month) cardiac magnetic resonance imaging and received an implantable cardioverter-defibrillator (ICD). On T2-weighted sequences, ME was found in 18 of 101 (18%) patients. According to cardiac magnetic resonance imaging findings, the arrhythmic SCA was ascribed to acute myocardial injury (either ischemic [n=10] or inflammatory [n=8]), to chronic structural heart diseases (ischemic heart disease [n=11], cardiomyopathy [n=20], or other [n=23]), or to primarily arrhythmic syndrome (n=29). During a follow-up of 47 months (28 to 67 months), 24 of 101 (24%) patients received an appropriate ICD intervention. ME was associated with a significantly higher survival free from both any ICD interventions (log-rank=0.04) and ICD shocks (log-rank=0.03) and remained an independent predictor of better arrhythmic outcome after adjustment for left ventricular ejection fraction and late gadolinium enhancement. The risk of appropriate ICD intervention was unrelated to the type of underlying heart disease. Conclusions ME on early cardiac magnetic resonance imaging, which denotes an acute and transient arrhythmogenic substrate, predicted a favorable long-term arrhythmic outcome of SCA survivors. These findings may have a substantial impact on future guidelines on the management of SCA survivors.
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MESH Headings
- Arrhythmias, Cardiac/diagnostic imaging
- Arrhythmias, Cardiac/therapy
- Contrast Media
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Edema
- Female
- Gadolinium
- Humans
- Magnetic Resonance Imaging
- Magnetic Resonance Imaging, Cine
- Magnetic Resonance Spectroscopy
- Male
- Middle Aged
- Out-of-Hospital Cardiac Arrest
- Prognosis
- Risk Factors
- Stroke Volume
- Survivors
- Ventricular Function, Left
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PaduaItaly
| | - Giulia Mattesi
- Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PaduaItaly
| | - Enrico Baldi
- Section of CardiologyDepartment of Molecular MedicineUniversity of PaviaItaly
- Cardiac Intensive Care UnitArrhythmia and Electrophysiology and Experimental CardiologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Mauro Toniolo
- Cardiothoracic DepartmentUniversity Hospital of UdineUdineItaly
| | - Federico Guerra
- Cardiology and Arrhythmology ClinicMarche Polytechnic UniversityUniversity Hospital “Ospedali Riuniti Umberto I – Lancisi – Salesi”AnconaItaly
| | - Filippo Maria Cauti
- Arrhythmology UnitCardiology DivisionS. Giovanni Calibita HospitalIsola Tiberina, RomeItaly
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PaduaItaly
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PaduaItaly
| | - Daniele Muser
- Cardiothoracic DepartmentUniversity Hospital of UdineUdineItaly
| | - Giulia Stronati
- Cardiology and Arrhythmology ClinicMarche Polytechnic UniversityUniversity Hospital “Ospedali Riuniti Umberto I – Lancisi – Salesi”AnconaItaly
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology UnitCardiology DepartmentSanta Maria Della Misericordia HospitalRovigoItaly
| | - Massimiliano Manfrin
- Electrophysiology and Cardiac Pacing UnitSan Maurizio Regional HospitalBolzanoItaly
| | | | | | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PaduaItaly
| | - Simone Savastano
- Division of CardiologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PaduaItaly
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6
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Affiliation(s)
- Daniel E Clark
- Division of Cardiovascular Medicine Department of Internal Medicine Vanderbilt University Medical Center Nashville TN
| | - Sean G Hughes
- Division of Cardiovascular Medicine Department of Internal Medicine Vanderbilt University Medical Center Nashville TN
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7
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Baritussio A, Biglino G, Scatteia A, De Garate E, Dastidar AG, Palazzuoli A, Harries I, Strange JW, Diab I, Bucciarelli-Ducci C. Long-term outcome of myocardial scarring and deformation with cardiovascular magnetic resonance in out of hospital cardiac arrest survivors. Eur Heart J Cardiovasc Imaging 2021; 22:1149-1156. [PMID: 33247898 DOI: 10.1093/ehjci/jeaa293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) is increasingly recognized as a diagnostic and prognostic tool in out of hospital cardiac arrest (OHCA) survivors. After assessing CMR findings early after ventricular fibrillation (VF) OHCA, we sought to explore the long-term outcome of myocardial scarring and deformation. METHODS AND RESULTS We included 121 consecutive VF OHCA survivors (82% male, median 62 years) undergoing CMR within 2 weeks from cardiac arrest. Late gadolinium-enhancement (LGE) was quantified using the full width at half maximum method and tissue tracking analysis software was used to assess myocardial deformation. LGE was found in 71% of patients (median LGE mass 6.2% of the left ventricle, LV), mainly with an ischaemic pattern. Myocardial deformation was overall impaired and showed a significant correlation with LGE presence and extent (P < 0.001). A composite end-point of all-cause mortality and appropriate ICD discharge/anti-tachycardia pacing was met in 24% of patients. Patients meeting the end-point had significantly greater LGE extent (8.6% of LV myocardium vs. 4.1%, P = 0.02), while there was no difference with regards to myocardial deformation. Survival rate was significantly lower in patients with LGE (P = 0.05) and LGE mass >4.4% of the LV identified a group of patients at higher risk of adverse events (P = 0.005). CONCLUSIONS We found a high prevalence of LGE, early after OHCA, and an overall impaired myocardial deformation. On long-term follow-up both LGE presence and extent showed a significant association with recurrent adverse events, while LV ejection fraction and myocardial deformation did not identify patients with an unfavourable outcome.
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Affiliation(s)
- Anna Baritussio
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Giovanni Biglino
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Alessandra Scatteia
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Estefania De Garate
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Amardeep Ghosh Dastidar
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, University of Siena, Siena 53100, Italy
| | - Iwan Harries
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Julian W Strange
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Ihab Diab
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK
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8
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Cardiac Magnetic Resonance Imaging for Nonischemic Cardiac Disease in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management: A Multicenter Retrospective Analysis. J Clin Med 2021; 10:jcm10040794. [PMID: 33669339 PMCID: PMC7920317 DOI: 10.3390/jcm10040794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/06/2021] [Accepted: 02/13/2021] [Indexed: 01/10/2023] Open
Abstract
(1) Background: Cardiac magnetic resonance (CMR) imaging is an emerging tool for investigating nonischemic cardiomyopathies and cardiac systemic disease. However, data on the cardiac arrest population are limited. This study aimed to evaluate the usefulness of CMR imaging in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). (2) Methods: We conducted the retrospective observational study using a multicenter registry of adult non-traumatic comatose OHCA survivors who underwent TTM between January 2010 and December 2019. Of the 949 patients, 389 with OHCA of non-cardiac cause, 145 with significant lesions in the coronary artery, 151 who died during TTM, 81 without further evaluation due to anticipated poor neurological outcome, and 51 whose etiology is underlying disease were excluded. In 36 of the 132 remaining patients, the etiologies included variant angina, long QT syndrome, and complete atrioventricular block in ancillary studies. Fifty-six patients were diagnosed idiopathic ventricular fibrillation without CMR. (3) Results: CMR imaging was performed in the remaining 40 patients with cardiac arrest of unknown cause. The median time from cardiac arrest to CMR imaging was 10.1 days. The CMR finding was normal in 23 patients, non-diagnostic in 12, and abnormal in 5, which suggested non-ischemic cardiomyopathy but did not support the final diagnosis. (4) Conclusions: CMR imaging may not be useful for identifying unknown causes of cardiac arrest in OHCA survivors treated with targeted temperature management without definitive diagnosis even after coronary angiography, echocardiography, and electrophysiology studies. However, further large-scale studies will be needed to confirm these findings.
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Chatterjee NA, Rea TD. Secondary prevention of sudden cardiac death. Heart Rhythm O2 2020; 1:297-310. [PMID: 34113884 PMCID: PMC8183887 DOI: 10.1016/j.hroo.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The prevention and treatment of sudden cardiac death (SCD) remains a significant public health challenge. For patients with a history of sudden death attributable to ventricular arrhythmia, implantable cardioverter-defibrillator (ICD) therapy is a mainstay of treatment, although these patients remain at high risk for recurrent ventricular arrhythmia and defibrillator therapies. In this review, we summarize landmark clinical trials evaluating the efficacy of ICD therapy in secondary prevention patients, review clinical outcomes including mode of death in survivors of SCD, and highlight the role for systematic diagnostic evaluation. We additionally discuss the invasive electrophysiological management of these patients, including ICD selection and programming as well as the role and timing of antiarrhythmic drug therapy and catheter ablation. Finally, we frame future challenges and needs to advance the care for secondary prevention patients.
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Affiliation(s)
- Neal A Chatterjee
- Electrophysiology Section, Cardiology Division, University of Washington, Seattle, Washington
| | - Thomas D Rea
- Division of General Internal Medicine, University of Washington, Seattle, Washington
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Affiliation(s)
- Moises Vasquez
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
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Muser D, Santangeli P, Selvanayagam JB, Nucifora G. Role of Cardiac Magnetic Resonance Imaging in Patients with Idiopathic Ventricular Arrhythmias. Curr Cardiol Rev 2019; 15:12-23. [PMID: 30251607 PMCID: PMC6367696 DOI: 10.2174/1573403x14666180925095923] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 01/14/2023] Open
Abstract
Ventricular Arrhythmias (VAs) may present with a wide spectrum of clinical manifestations ranging from mildly symptomatic frequent premature ventricular contractions to lifethreatening events such as sustained ventricular tachycardia, ventricular fibrillation and sudden cardiac death. Myocardial scar plays a central role in the genesis and maintenance of re-entrant arrhythmias which are commonly associated with Structural Heart Diseases (SHD) such as ischemic heart disease, healed myocarditis and non-ischemic cardiomyopathies. However, the arrhythmogenic substrate may remain unclear in up to 50% of the cases after a routine diagnostic workup, comprehensive of 12-lead surface ECG, transthoracic echocardiography and coronary angiography/ computed tomography. Whenever any abnormality cannot be identified, VAs are referred as to "idiopathic". In the last decade, Cardiac Magnetic Resonance (CMR) imaging has acquired a growing role in the identification and characterization of myocardial arrhythmogenic substrate, not only being able to accurately and reproducibly quantify biventricular function, but, more importantly, providing information about the presence of myocardial structural abnormalities such as myocardial fatty replacement, myocardial oedema, and necrosis/ fibrosis, which may otherwise remain unrecognized. Moreover, CMR has recently demonstrated to be of great value in guiding interventional treatments, such as radiofrequency ablation, by reliably identifying VA sites of origin and improving long-term outcomes. In the present manuscript, we review the available data regarding the utility of CMR in the workup of apparently "idiopathic" VAs with a special focus on its prognostic relevance and its application in planning and guiding interventional treatments.
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Affiliation(s)
| | | | | | - Gaetano Nucifora
- Address correspondence to this author author at the Cardiac Imaging Unit, Manchester University NHS Foundation Trust, Manchester, UK; E-mail:
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12
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Waldmann V, Bougouin W, Karam N, Dumas F, Sharifzadehgan A, Gandjbakhch E, Algalarrondo V, Narayanan K, Zhao A, Amet D, Jost D, Geri G, Lamhaut L, Beganton F, Ludes B, Bruneval P, Plu I, Hidden-Lucet F, Albuisson J, Lavergne T, Piot O, Alonso C, Leenhardt A, Lellouche N, Extramiana F, Cariou A, Jouven X, Marijon E. Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation. Eur Heart J 2018; 39:1981-1987. [PMID: 29566157 PMCID: PMC5982722 DOI: 10.1093/eurheartj/ehy098] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/30/2017] [Accepted: 02/13/2018] [Indexed: 12/22/2022] Open
Abstract
Aims Recent studies have shown that in more than half of apparently unexplained sudden cardiac arrests (SCA), a specific aetiology can be unmasked by a careful evaluation. The characteristics and the extent to which such cases undergo a systematic thorough investigation in real-life practice are unknown. Methods and results Data were analysed from an ongoing study, collecting all cases of out-of-hospital cardiac arrest in Paris area. Investigations performed during the index hospitalization or planned after discharge were gathered to evaluate the completeness of assessment of unexplained SCA. Between 2011 and 2016, among the 18 622 out-of-hospital cardiac arrests, 717 survivors (at hospital discharge) fulfilled the definition of cardiac SCA. Of those, 88 (12.3%) remained unexplained after electrocardiogram, echocardiography, and coronary angiography. Cardiac magnetic resonance imaging yielded the diagnosis in 25 (3.5%) cases, other investigations accounted for 14 (2.4%) additional diagnoses, and 49 (6.8%) patients were labelled as idiopathic ventricular fibrillation (IVF) (48.7 ± 15 years, 69.4% male). Among those labelled IVF, only 8 (16.3%) cases benefited from a complete workup (including pharmacological testing). Younger patients [odds ratio (OR) 6.00, 95% confidence interval (CI) 1.80-22.26] and those admitted to university centres (OR 3.60, 95% CI 1.12-12.45) were more thoroughly investigated. Genetic testing and family screening were initiated in only 9 (18.4%) and 12 (24.5%) cases, respectively. Conclusion Our findings suggest that complete investigations are carried out in a very low proportion of unexplained SCA. Standardized, systematic approaches need to be implemented to ensure that opportunities for specific therapies and preventive strategies (including relatives) are not missed.
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Affiliation(s)
- Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Wulfran Bougouin
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Nicole Karam
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Emergency Department, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Ardalan Sharifzadehgan
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
| | - Estelle Gandjbakhch
- Cardiology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, Antoine-Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140 Clamart, France
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Cardiology Department, Maxcure Hospitals, Behind Cyber Towers, Hitec City, 500081 Hyderabad, India
| | - Alexandre Zhao
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Denis Amet
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Daniel Jost
- Paris Firefighters Brigade, 1 Place Jules Renard, 75017 Paris, France
| | - Guillaume Geri
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Intensive Care Unit, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Lionel Lamhaut
- SAMU de Paris, Necker Hospital, 149 rue Sèvres, 75015 Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
| | - Bertrand Ludes
- Forensic Medical Institute, 2 Voie Mazas, 75012 Paris, France
| | - Patrick Bruneval
- Pathology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Isabelle Plu
- Pathology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Françoise Hidden-Lucet
- Cardiology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Juliette Albuisson
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Genetic Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Thomas Lavergne
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Olivier Piot
- Cardiology Department, Centre Cardiologique du Nord, 32-36 Rue des Moulins Gémeaux, 93200 Saint-Denis, France
| | - Christine Alonso
- Cardiology Department, Clinique Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - Antoine Leenhardt
- Cardiology Department, Bichat-Claude-Bernard Hospital, 46 Rue Henri Huchard, 75877 Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, University Hospital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, Bichat-Claude-Bernard Hospital, 46 Rue Henri Huchard, 75877 Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Intensive Care Unit, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
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Zorzi A, Susana A, De Lazzari M, Migliore F, Vescovo G, Scarpa D, Baritussio A, Tarantini G, Cacciavillani L, Giorgi B, Basso C, Iliceto S, Bucciarelli Ducci C, Corrado D, Perazzolo Marra M. Diagnostic value and prognostic implications of early cardiac magnetic resonance in survivors of out-of-hospital cardiac arrest. Heart Rhythm 2018; 15:1031-1041. [PMID: 29550522 DOI: 10.1016/j.hrthm.2018.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In patients who survived out-of-hospital cardiac arrest (OHCA), it is crucial to establish the underlying cause and its potential reversibility. OBJECTIVE The purpose of this study was to assess the incremental diagnostic and prognostic role of early cardiac magnetic resonance (CMR) in survivors of OHCA. METHODS Among 139 consecutive OHCA patients, the study enrolled 44 patients (median age 43 years; 84% male) who underwent coronary angiography and CMR ≤7 days after admission. The CMR protocol included T2-weighted sequences for myocardial edema and late gadolinium enhancement (LGE) sequences for myocardial fibrosis. RESULTS Coronary angiography identified obstructive coronary artery disease in 18 of 44 patients in whom CMR confirmed the diagnosis of ischemic heart disease by demonstrating subendocardial or transmural LGE. The presence of myocardial edema allowed differentiation between acute myocardial ischemia (n = 12) and postinfarction myocardial scar (n = 6). Among the remaining 26 patients without obstructive coronary artery disease, CMR in 19 (73%) showed dilated cardiomyopathy in 5, myocarditis in 4, mitral valve prolapse associated with LGE in 3, ischemic scar in 2, idiopathic nonischemic scar in 2, arrhythmogenic cardiomyopathy in 1, hypertrophic cardiomyopathy in 1, and takotsubo cardiomyopathy in 1. In this subgroup of 26 patients, 6 (23%) had myocardial edema. During mean follow-up of 36 ± 17 months, all 18 patients with myocardial edema had an uneventful outcome, whereas 9 of 26 (35%) without myocardial edema experienced sudden arrhythmic death (n = 1), appropriate defibrillator interventions (n = 5), and nonarrhythmic death (n = 3; P = .006). CONCLUSION In survivors of OHCA, early CMR with a comprehensive tissue characterization protocol provided additional diagnostic and prognostic value. The identification of myocardial edema was associated with a favorable long-term outcome.
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Affiliation(s)
- Alessandro Zorzi
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Angela Susana
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Manuel De Lazzari
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giovanni Vescovo
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Daniele Scarpa
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Anna Baritussio
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy; Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Luisa Cacciavillani
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Benedetta Giorgi
- Division of Radiology, Department of Medicine, Az. Ospedaliera di Padova, Padova, Italy
| | - Cristina Basso
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Chiara Bucciarelli Ducci
- Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Domenico Corrado
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
| | - Martina Perazzolo Marra
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Bougouin W, Cariou A. Aetiologies of cardiac arrest: Seek and ye shall find. Resuscitation 2017; 116:A3-A4. [DOI: 10.1016/j.resuscitation.2017.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
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