Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy; Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
Heart Rhythm. 2018 Jul;15(7):1031-1041. doi: 10.1016/j.hrthm.2018.02.033. Epub 2018 Mar 15.
In patients who survived out-of-hospital cardiac arrest (OHCA), it is crucial to establish the underlying cause and its potential reversibility.
The purpose of this study was to assess the incremental diagnostic and prognostic role of early cardiac magnetic resonance (CMR) in survivors of OHCA.
Among 139 consecutive OHCA patients, the study enrolled 44 patients (median age 43 years; 84% male) who underwent coronary angiography and CMR ≤7 days after admission. The CMR protocol included T2-weighted sequences for myocardial edema and late gadolinium enhancement (LGE) sequences for myocardial fibrosis.
Coronary angiography identified obstructive coronary artery disease in 18 of 44 patients in whom CMR confirmed the diagnosis of ischemic heart disease by demonstrating subendocardial or transmural LGE. The presence of myocardial edema allowed differentiation between acute myocardial ischemia (n = 12) and postinfarction myocardial scar (n = 6). Among the remaining 26 patients without obstructive coronary artery disease, CMR in 19 (73%) showed dilated cardiomyopathy in 5, myocarditis in 4, mitral valve prolapse associated with LGE in 3, ischemic scar in 2, idiopathic nonischemic scar in 2, arrhythmogenic cardiomyopathy in 1, hypertrophic cardiomyopathy in 1, and takotsubo cardiomyopathy in 1. In this subgroup of 26 patients, 6 (23%) had myocardial edema. During mean follow-up of 36 ± 17 months, all 18 patients with myocardial edema had an uneventful outcome, whereas 9 of 26 (35%) without myocardial edema experienced sudden arrhythmic death (n = 1), appropriate defibrillator interventions (n = 5), and nonarrhythmic death (n = 3; P = .006).
In survivors of OHCA, early CMR with a comprehensive tissue characterization protocol provided additional diagnostic and prognostic value. The identification of myocardial edema was associated with a favorable long-term outcome.
在院外心脏骤停（OHCA）存活的患者中，确定根本原因及其潜在可逆性至关重要。
本研究旨在评估早期心脏磁共振（CMR）在 OHCA 幸存者中的额外诊断和预后作用。
在连续的 139 例 OHCA 患者中，该研究纳入了 44 例患者（中位年龄 43 岁；84%为男性），他们在入院后≤7 天内接受了冠状动脉造影和 CMR。CMR 方案包括心肌水肿的 T2 加权序列和心肌纤维化的晚期钆增强（LGE）序列。
冠状动脉造影在 44 例患者中发现 18 例有阻塞性冠状动脉疾病，其中 CMR 通过显示心内膜下或透壁 LGE 证实缺血性心脏病的诊断。心肌水肿的存在可区分急性心肌缺血（n = 12）和梗死后心肌瘢痕（n = 6）。在其余 26 例无阻塞性冠状动脉疾病的患者中，CMR 在 19 例（73%）中显示扩张型心肌病 5 例、心肌炎 4 例、二尖瓣脱垂伴 LGE 3 例、缺血性瘢痕 2 例、特发性非缺血性瘢痕 2 例、致心律失常性右室心肌病 1 例、肥厚型心肌病 1 例和心尖球形综合征 1 例。在这 26 例患者亚组中，有 6 例（23%）有心肌水肿。在平均 36 ± 17 个月的随访中，所有 18 例有心肌水肿的患者均未发生不良事件，而在 26 例无心肌水肿的患者中，有 9 例（35%）发生了心律失常性猝死（n = 1）、适当的除颤器干预（n = 5）和非心律失常性死亡（n = 3；P =.006）。
在 OHCA 幸存者中，早期 CMR 结合全面的组织特征化方案提供了额外的诊断和预后价值。心肌水肿的识别与良好的长期预后相关。
