title: Late gadolinium enhancement among survivors of sudden cardiac arrest.
abstract: OBJECTIVE
  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.
authors: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Tomas G
authors: TG
authors: Neilan
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Hoshang
authors: H
authors: Farhad
authors: Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Thomas
authors: T
authors: Mayrhofer
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Ravi V
authors: RV
authors: Shah
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: John A
authors: JA
authors: Dodson
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Siddique A
authors: SA
authors: Abbasi
authors: Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors: Stephan B
authors: SB
authors: Danik
authors: Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Daniel J
authors: DJ
authors: Verdini
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Michifumi
authors: M
authors: Tokuda
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Usha B
authors: UB
authors: Tedrow
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Michael
authors: M
authors: Jerosch-Herold
authors: Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Udo
authors: U
authors: Hoffmann
authors: Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Brian B
authors: BB
authors: Ghoshhajra
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: William G
authors: WG
authors: Stevenson
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: rykwong@partners.org.
authors: Raymond Y
authors: RY
authors: Kwong
mesh_terms: D003287:Contrast Media; D017023:Coronary Angiography; D016757:Death, Sudden, Cardiac / Q000473:pathology*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D017741:Survivors
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: cardiac magnetic resonance; implantable cardioverter-defibrillator; late gadolinium enhancement