Rodrigues Patricia, Joshi Abhishek, Williams Howell, Westwood Mark, Petersen Steffen E, Zemrak Filip, Schilling Richard J, Kirkby Claire, Wragg Andrew, Manisty Charlotte, Mohiddin Saidi
From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.).
Circ Cardiovasc Imaging. 2017 Dec;10(12):e006709. doi: 10.1161/CIRCIMAGING.117.006709.
Determining the pathogenesis of sudden cardiac arrest or periarrest without significant coronary artery disease is crucial for management and prognosis. Cardiovascular magnetic resonance (CMR) can detect morphological, functional, or tissue abnormalities, and we sought to evaluate the role of CMR in determining sudden cardiac arrest pathogenesis and prognosis in survivors.
We retrospectively reviewed cardiac investigations and clinical outcomes in consecutive survivors of potentially fatal arrhythmias without coronary artery disease admitted to our institutions from 2008 to 2014. After coronary angiography and echocardiography, all underwent CMR and, when indicated, electrophysiology studies. Major adverse cardiac events (MACE), comprising significant nonfatal ventricular arrhythmia or death, was the primary outcome. Of 164 included subjects (65% men; mean age 48 [18-80] years), CMR contributed to the diagnosis in 80 (49%) and was decisive in 50 cases (30%). Dilated cardiomyopathy (n=27), myocarditis or sarcoidosis (n=22), occult myocardial infarction (n=13), and hypertrophic cardiomyopathy (n=9) were most frequent. Arrhythmic causes were found in 14% while no cause was identified in 36%. MACE occurred in 31% of subjects during a median follow-up of 32 months. MACE associated with presence of a CMR diagnosis, extent of late gadolinium enhancement, and left and right ventricular ejection fractions. Right ventricular ejection fraction was an independent predictor of MACE.
CMR identified a likely pathogenesis for sudden cardiac arrest in nearly half of survivors in whom coronary artery disease had been excluded. One in 3 subjects had MACE; risk doubled in those with a CMR diagnosis and some CMR parameters-late gadolinium enhancement, left ventricular ejection fraction, and especially right ventricular ejection fraction-associated with prognosis.
确定无明显冠状动脉疾病的心脏骤停或心脏骤停前期的发病机制对治疗和预后至关重要。心血管磁共振成像（CMR）能够检测形态、功能或组织异常，我们旨在评估CMR在确定心脏骤停幸存者发病机制和预后方面的作用。
我们回顾性分析了2008年至2014年期间我院收治的无冠状动脉疾病的潜在致命性心律失常连续幸存者的心脏检查及临床结果。在进行冠状动脉造影和超声心动图检查后，所有患者均接受CMR检查，必要时进行电生理检查。主要不良心脏事件（MACE），包括严重非致命性室性心律失常或死亡，是主要观察指标。在纳入的164例受试者（65%为男性；平均年龄48[18 - 80]岁）中，CMR有助于诊断80例（49%），并在50例（30%）中起决定性作用。扩张型心肌病（n = 27）、心肌炎或结节病（n = 22）、隐匿性心肌梗死（n = 13）和肥厚型心肌病（n = 9）最为常见。14%发现心律失常病因，36%未发现病因。在中位随访32个月期间，31%的受试者发生MACE。MACE与CMR诊断的存在、延迟钆增强程度以及左、右心室射血分数相关。右心室射血分数是MACE的独立预测因素。
CMR在近一半排除冠状动脉疾病的心脏骤停幸存者中确定了可能的发病机制。三分之一的受试者发生MACE；CMR诊断阳性者风险加倍，一些CMR参数——延迟钆增强、左心室射血分数，尤其是右心室射血分数——与预后相关。
