Utility of Cardiovascular Magnetic Resonance in Identifying Substrate for Malignant Ventricular Arrhythmias

Authors

James A. White, The University of Western Ontario
Nowell M. Fine, The University of Western Ontario
Lorne Gula, The University of Western Ontario
Raymond Yee, The University of Western Ontario
Allan Skanes, The University of Western Ontario
George Klein, The University of Western Ontario
Peter Leong-Sit, The University of Western Ontario
Heather Warren, The University of Western Ontario
Terry Thompson, The University of Western Ontario
Maria Drangova, The University of Western Ontario
Andrew Krahn, The University of Western Ontario

Document Type

Article

Publication Date

1-1-2012

Journal

Circulation: Cardiovascular Imaging

Volume

5

Issue

1

First Page

12

Last Page

20

URL with Digital Object Identifier

http://dx.doi.org/10.1161/CIRCIMAGING.111.966085

Abstract

Background- Sudden cardiac death (SCD) and sustained monomorphic ventricular tachycardia (SMVT) are frequently associated with prior or acute myocardial injury. Cardiovascular magnetic resonance (CMR) provides morphological, functional, and tissue characterization in a single setting. We sought to evaluate the diagnostic yield of CMR-based imaging versus non-CMR-based imaging in patients with resuscitated SCD or SMVT. Methods and Results- Eighty-two patients with resuscitated SCD or SMVT underwent routine non-CMR imaging, followed by a CMR protocol with comprehensive tissue characterization. Clinical reports of non-CMR imaging studies were blindly adjudicated and used to assign each patient to 1 of 7 diagnostic categories. CMR imaging was blindly interpreted using a standardized algorithm used to assign a patient diagnosis category in a similar fashion. The diagnostic yield of CMR-based and non-CMR-based imaging, as well as the impact of the former on diagnosis reclassification, was established. Relevant myocardial disease was identified in 51% of patients using non-CMR-based imaging and in 74% using CMR-based imaging (P=0.002). Forty-one patients (50%) were reassigned to a new or alternate diagnosis using CMR-based imaging, including 15 (18%) with unsuspected acute myocardial injury. Twenty patients (24%) had no abnormality by non-CMR imaging but showed clinically relevant myocardial disease by CMR imaging. Conclusions- CMR-based imaging provides a robust diagnostic yield in patients presenting with resuscitated SCD or SMVT and incrementally identifies clinically unsuspected acute myocardial injury. When compared with non-CMR-based imaging, a new or alternate myocardial disease process may be identified in half of these patients.

Notes

A video about this study is embedded below.

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