Late gadolinium enhancement among survivors of sudden cardiac arrest

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; Jerosch Herold Michael; Udo Hoffmann; Brian B. Ghoshhajra; William G. Stevenson; Raymond Y. Kwong

doi:10.1016/j.jcmg.2014.11.017

Late gadolinium enhancement among survivors of sudden cardiac arrest

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, Jerosch Herold Michael, Udo Hoffmann, Brian B. Ghoshhajra, William G. Stevenson, Raymond Y. Kwong

Research output: Contribution to journal › Article › peer-review

91 Scopus citations

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.

Original language	English
Pages (from-to)	414-423
Number of pages	10
Journal	JACC: Cardiovascular Imaging
Volume	8
Issue number	4
DOIs	https://doi.org/10.1016/j.jcmg.2014.11.017
State	Published - 1 Apr 2015
Externally published	Yes

Keywords

cardiac magnetic resonance
implantable cardioverter-defibrillator
late gadolinium enhancement

Access to Document

10.1016/j.jcmg.2014.11.017

Cite this

Neilan, T. G., Farhad, H., Mayrhofer, T., Shah, R. V., Dodson, J. A., Abbasi, S. A., Danik, S. B., Verdini, D. J., Tokuda, M., Tedrow, U. B., Michael, J. H., Hoffmann, U., Ghoshhajra, B. B., Stevenson, W. G., & Kwong, R. Y. (2015). Late gadolinium enhancement among survivors of sudden cardiac arrest. JACC: Cardiovascular Imaging, 8(4), 414-423. https://doi.org/10.1016/j.jcmg.2014.11.017

@article{743242fce9384f3ab3bd5335ef323d3e,

title = "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.",

keywords = "cardiac magnetic resonance, implantable cardioverter-defibrillator, late gadolinium enhancement",

author = "Neilan, {Tomas G.} and Hoshang Farhad and Thomas Mayrhofer and Shah, {Ravi V.} and Dodson, {John A.} and Abbasi, {Siddique A.} and Danik, {Stephan B.} and Verdini, {Daniel J.} and Michifumi Tokuda and Tedrow, {Usha B.} and Michael, {Jerosch Herold} and Udo Hoffmann and Ghoshhajra, {Brian B.} and Stevenson, {William G.} and Kwong, {Raymond Y.}",

note = "Publisher Copyright: {\textcopyright} 2015 American College of Cardiology Foundation.",

year = "2015",

month = apr,

day = "1",

doi = "10.1016/j.jcmg.2014.11.017",

language = "English",

volume = "8",

pages = "414--423",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "4",

}

TY - JOUR

T1 - Late gadolinium enhancement among survivors of sudden cardiac arrest

AU - Neilan, Tomas G.

AU - Farhad, Hoshang

AU - Mayrhofer, Thomas

AU - Shah, Ravi V.

AU - Dodson, John A.

AU - Abbasi, Siddique A.

AU - Danik, Stephan B.

AU - Verdini, Daniel J.

AU - Tokuda, Michifumi

AU - Tedrow, Usha B.

AU - Michael, Jerosch Herold

AU - Hoffmann, Udo

AU - Ghoshhajra, Brian B.

AU - Stevenson, William G.

AU - Kwong, Raymond Y.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - 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.

AB - 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.

KW - cardiac magnetic resonance

KW - implantable cardioverter-defibrillator

KW - late gadolinium enhancement

UR - http://www.scopus.com/inward/record.url?scp=84928109983&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2014.11.017

DO - 10.1016/j.jcmg.2014.11.017

M3 - Article

C2 - 25797123

AN - SCOPUS:84928109983

SN - 1936-878X

VL - 8

SP - 414

EP - 423

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 4

ER -

Late gadolinium enhancement among survivors of sudden cardiac arrest

Abstract

Keywords

Access to Document

Fingerprint

Cite this