CMR in Phenotyping the Arrhythmic Substrate

Author:

Morgan Róisín B.,Kwong Raymond Y.

Publisher

Springer Science and Business Media LLC

Subject

Cell Biology,Applied Microbiology and Biotechnology,Histology

Reference116 articles.

1. • Mavrogeni S, Petrou E, Kolovou G, Theodorakis G, Iliodromitis E. Prediction of ventricular arrhythmias using cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging. 2013;14(6):518–25. This recent article discusses the use of CMR in evaluation of patients with myocardial conditions associated with ventricular arrhythmias and subsequent adverse outcomes. It highlights the advantages of CMR in the evaluation of patients with CAD, HCM, DCM, ARVC and congenital heart disease.

2. Buxton AE, Lee KL, Hafley GE, Pires LA, Fisher JD, Gold MR, et al. Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. J Am Coll Cardiol. 2007;50(12):1150–7.

3. Kalahasti V, Nambi V, Martin DO, Lam CT, Yamada D, Wilkoff BL, et al. QRS duration and prediction of mortality in patients undergoing risk stratification for ventricular arrhythmias. Am J Cardiol. 2003;92(7):798–803.

4. • Neilan TG, Farhad H, Mayrhofer T, Shah RV, Dodson JA, Abbasi SA, et al. Late gadolinium enhancement among survivors of sudden cardiac arrest. JACC Cardiovasc Imaging. 2015;8(4):414–23. The hypothesis behind this article was based on the fact that myocardial fibrosis is a key substrate for sudden cardiac arrest(SCA), and LGE imaging on CMR is a robust technique for imaging of myocardial fibrosis. Through a retrospective review of all survivors of SCA referred for a CMR study at this institution and subsequent follow-up to assess outcomes, this study showed that among patients with SCA, CMR with contrast identified LGE in 71% and provided a potential arrhythmic substrate in 76% of cases. In a median follow-up of 29 months, both the presence and extent of LGE identified a group at increased risk of future adverse events. This study highlights the additive value of a contrast CMR study in survivors of SCA, especially when an initial workup is unrevealing. Almost 45% of patients in this study either died or had appropriate ICD therapy in follow-up and the presence and the extent of LGE on CMR provided strong and independent prognostic information among this high-risk cohort.

5. Stevenson WG, Epstein LM. Predicting sudden death risk for heart failure patients in the implantable cardioverter-defibrillator age. Circulation. 2003;107(4):514–6.

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