Key result
In sudden cardiac arrest survivors, T1 elevation on cardiovascular magnetic resonance was not significantly associated with all-cause mortality or heart transplant (HR 3.25), though parametric mapping aided in diagnosing etiology in 66% of cases.
Why the study?
The etiology of sudden cardiac arrest is identified in less than 30% of survivors without coronary artery disease, prompting assessment of myocardial parametric mapping on CMR.
Does the inclusion of quantitative T1 and T2 parametric mapping in CMR improve the diagnostic yield for identifying the etiology of sudden cardiac arrest in survivors?
Cohort (n=35)
No
Does the inclusion of quantitative T1 and T2 parametric mapping in CMR improve the diagnostic yield for identifying the etiology of sudden cardiac arrest in survivors?
Hazard Ratio: 3.25 (95% CI 0.36–29.7)
p-value: p=0.30
Adding T1 and T2 parametric mapping to CMR protocols for sudden cardiac arrest survivors significantly improves the identification of the underlying etiology, particularly for myocarditis, which can aid in decision-making regarding ICD implantation.
T1 elevation should not yet guide prognosis in sudden cardiac arrest survivors; leaves open parametric mapping's diagnostic role pending larger validation.
Purpose 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. Methods 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 the CMR diagnosis if the SCA etiology could have not been determined without its utilization, and contributory if the diagnosis could have been potentially based on the combination of cine and LGE imaging, without optimal assessment of the severity and prognosis of the disease (offered by parametric mapping). Results Of the 35 patients (mean age 46.9 ± 14.1 years; 57% males) included, 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. Conclusion 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. CMR performed early after SCA may aid in the decision-making regarding ICD implantation.
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Gil et al. (2023) conducted a cohort in Sudden cardiac arrest (n=35). T1 elevation on cardiovascular magnetic resonance vs. Normal T1 was evaluated on All-cause mortality or heart transplant (HR 3.25, 95% CI 0.36-29.7, p=0.30). In sudden cardiac arrest survivors, T1 elevation on cardiovascular magnetic resonance was not significantly associated with all-cause mortality or heart transplant (HR 3.25), though parametric mapping aided in diagnosing etiology in 66% of cases.
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