391 Post-Mortem Cardiac Magnetic Resonance Parameters

Abstract

Post-mortem cardiac magnetic resonance (CMR) is a non-invasive alternative to conventional autopsy for assessing unexplained death. However, some cardiac pathologies are difficult to diagnose using the current ante-mortem derived diagnostic parameters. We evaluated post-mortem CMR (Siemens Sonata 1.5T) in subjects under coronial investigation for unexplained death in South Australia between 2014-2016. Causes of death were determined by conventional autopsy. 69 scans were assessed with a median age of 60 years [49–68]. 41(60.3%) died from non-cardiac causes and had no cardiac abnormality, twelve had LV disease (ten(14.7%) myocardial infarction and 2(2.9%) myocarditis) and 16 had RV disease (11(16.2%) pulmonary emboli and five(7.4%) arrhythmogenic right ventricular cardiomyopathy). In patients without cardiac disease, the median post-mortem septal and lateral wall thickness was 15mm [13–17] and 13mm [12–15]. Using ante-mortem definitions, 46.3% (19/41) would incorrectly satisfy the criteria for hypertrophic cardiomyopathy (>15mm). The median septal wall signal intensity (SI) was brighter than the lateral wall; 141SI [114–162] and 122SI [98–154], p=0.093. In patients with LV disease, the SI ratio of scar to normal myocardium was 1.6 [1.5–1.6] compared to 1.1 [1.0–1.2] for the SI ratio of septal to normal myocardium in those without scar; p=0.014. In patients with right ventricular (RV) disease, the median RV to LV ratio was 2.9 [2.5–3.0] compared to 1.8 [1.5–2.0] in those without disease; p<0.001. Some cardiac pathologies are difficult to diagnose in the post-mortem setting and require specific definitions.